Imaging Intensity and Survival Outcomes in High-Risk Resected Melanoma Treated by Systemic Therapy at Recurrence

A Correction to this article was published on 22 May 2020

This article has been updated

Abstract

Background

Intensive imaging in melanoma remains controversial because its survival impact is unknown. We investigated the impact of imaging intensity on the rates of asymptomatic surveillance-detected recurrence (ASDR) and subsequent treatment outcomes in patients with access to immune checkpoint inhibitors (ICIs) and targeted therapy (TT).

Methods

Patients with resected malignant melanoma undergoing imaging surveillance at a single center between 2006 and 2016 were identified. Surveillance and recurrence characteristics (imaging, symptom, treatment, and survival data) were retrospectively collected. Univariate (t test, Chi square test) and multivariate Cox regression analyses were conducted.

Results

Of 353 high-risk melanoma patients (stage IIB, 24%; IIC, 19%; IIIA, 27%; IIIB, 16%; IIIC, 14%), 71 (45%) had ASDR and 88 (55%) had symptomatic recurrence (SR). Shorter imaging intervals identified more ASDR (57%, 0–6 months; 34%, 6–12 months; 33%, > 12 months; p = 0.03). ASDR had better prognostic factors than SR [fewer than three metastatic sites (43 vs. 21%, p = 0.003), normal lactate dehydrogenase (LDH; 53 vs. 38%, p = 0.09), brain metastases (11 vs. 40%, p < 0.001)] and received more systemic treatment (72 vs. 49%, p = 0.003; ICIs 55 vs. 31%, p = 0.002; TT 8 vs. 13%, p = 0.41). ASDR had better survival outcomes on ICI treatment (2-year OS, 56 vs. 31%, p < 0.001). Median OS from surveillance start was 39.6 vs. 22.8 months (p < 0.001). ASDR was independently associated with survival (hazard ratio 0.47, 95% confidence interval 0.29–0.78, p = 0.003), adjusting for stage, sex, age, disease burden, LDH, era of recurrence, brain metastases, and ICI/TT treatment.

Conclusions

These real-world data support further study on intensified imaging surveillance protocols for high-risk resected melanoma, as ASDR was associated with superior survival outcomes from ICI therapy.

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Fig. 1

Change history

  • 22 May 2020

    In the original article, the survival curves are missing in Fig.��1c, d.

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Contributions

MO: Study conception and design, AMI, ML: Acquisition of data, MO, DB, HM: Analysis and interpretation of data, AMI, MO, ML: Manuscript Writing, MO, XS, DB, CN, HM: Critical revision, All authors read and final approval of the manuscript.

Corresponding author

Correspondence to Michael Ong MD, FRCPC.

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All authors read and approved the manuscript. This manuscript has not previously been published and is not currently under consideration for publication in any other journal. Michael Ong has been a consultant to and received honoraria from Bristol-Myers Squibb, Merck, AstraZeneca, and Roche/Genentech. Carolyn Nessim has received honoraria from Merck, EMD Serono and Novartis, and has been on an advisory board for Novartis. Xinni Song has been a consultant to and received honoraria from Bristol-Myers Squibb and Merck. Dominick Bossé has been a consultant to Bristol-Myers Squibb, Pfizer and AbbVie, and has received honoraria from AstraZeneca, Ipsen, Amgen and Janssen. Andrea Marie Ibrahim, Melanie Le May, and Horia Marginean declare they have no competing interests.

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Ibrahim, A.M., Le May, M., Bossé, D. et al. Imaging Intensity and Survival Outcomes in High-Risk Resected Melanoma Treated by Systemic Therapy at Recurrence. Ann Surg Oncol 27, 3683–3691 (2020). https://doi.org/10.1245/s10434-020-08407-8

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