Advertisement

Treatment and outcome trends and predictors of overall survival of rectal melanoma: Analysis of the National Cancer Database

  • Sameh Hany Emile
    Affiliations
    Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA

    Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt
    Search for articles by this author
  • Nir Horesh
    Affiliations
    Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA

    Department of Surgery and Transplantations, Sheba Medical Center, Ramat Gan, Affiliated with the Faculty of Medicine, Tel Aviv University, Israel
    Search for articles by this author
  • Michael R. Freund
    Affiliations
    Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA

    Department of General Surgery, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel
    Search for articles by this author
  • Zoe Garoufalia
    Affiliations
    Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA
    Search for articles by this author
  • Rachel Gefen
    Affiliations
    Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA

    Department of General Surgery, Faculty of Medicine, Hadassah Medical Organization, Hebrew University of Jerusalem, Israel
    Search for articles by this author
  • Emanuela Silva-Alvarenga
    Affiliations
    Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA
    Search for articles by this author
  • Steven D. Wexner
    Correspondence
    Corresponding author. Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.
    Affiliations
    Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA
    Search for articles by this author
Published:January 24, 2023DOI:https://doi.org/10.1016/j.ejso.2023.01.021

      Abstract

      Background

      We aimed to assess characteristics, treatment, and outcomes of rectal melanoma (RM).

      Methods

      This retrospective cohort study looked at patients with RM from National Cancer Database (2004–2019) analyzed characteristics and outcomes of the entire cohort and across three time periods (2004–2009; 2010–2014; 2015–2019). Main outcome measures were change in treatment and survival trends across time periods and overall survival (OS).

      Results

      641 patients (58.5% female; mean age: 68.2 ± 13.6 years) were included. OS rate was 26%; median survival duration was 17.9 (IQR: 15.93–20.67) months. There was a significant decrease in the use of chemotherapy (17.3%–6.6%; p = 0.001) and surgery (62.9%–41.8%; p = 0.00004) but increased use of immunotherapy (11.9%–52%; p < 0.001) across time periods. OS was longer in the last time period than in the first two (21.8 vs 16.8 vs 16.5 months; p = 0.09). Surgical excision was an independent predictor of improved OS (HR = 0.266, 95%CI: 0.089–0.789, p = 0.017) whereas older age (HR = 1.039, 95%CI: 1.007–1.072, p = 0.016), positive resection margins (HR = 5.06, 95%CI: 1.902–13.48, p = 0.001) and metastasis (HR = 34.62, 95%CI: 3.973–301.6, p = 0.001) were predictors of poor survival.

      Conclusions

      Over time, chemotherapy and surgery have been used less often in the treatment of RM while the use of immunotherapy increased by more than four-fold. Older age, surgical treatment, positive resection margins, and metastasis were predictive of survival of RM.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Surgical Oncology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Tan W.W.
        Malignant melanoma. Medscape.
        (Available online at)
        • Tacastacas J.D.
        • Bray J.
        • Cohen Y.K.
        • et al.
        Update on primary mucosal melanoma.
        J Am Acad Dermatol. 2014; 71: 366-375
        • Hillenbrand A.
        • Barth T.F.
        • Henne-Bruns D.
        • Formentini A.
        Anorectal amelanotic melanoma.
        Colorectal Dis. 2008; 10: 612-615
        • Malaguarnera G.
        • Madeddu R.
        • Catania V.E.
        • et al.
        Anorectal mucosal melanoma.
        Oncotarget. 2018; 9: 8785-8800
        • Wang S.
        • Sun S.
        • Liu X.
        • et al.
        Endoscopic diagnosis of primary anorectal melanoma.
        Oncotarget. 2017; 8: 50133-50140
        • Antoniuk P.M.
        • Tjandra J.J.
        • Webb B.W.
        • Petras R.E.
        • Milsom J.W.
        • Fazio V.W.
        Anorectal malignant melanoma has a poor prognosis.
        Int J Colorectal Dis. 1993; 8: 81-86
        • Matsuda A.
        • Miyashita M.
        • Matsumoto S.
        • Takahashi G.
        • Matsutani T.
        • Yamada T.
        • et al.
        Abdominoperineal resection provides better local control but equivalent overall survival to local excision of anorectal malignant melanoma: a systematic review.
        Ann Surg. 2015 Apr; 261: 670-677https://doi.org/10.1097/SLA.0000000000000862
        • Komatsubara K.M.
        • Jeter J.
        • Carvajal R.D.
        • Margolin K.
        • Schadendorf D.
        • Hauschild A.
        Advances in the treatment of advanced extracutaneous melanomas and nonmelanoma skin cancers.
        Am Soc Clin Oncol Educ Book. 2017; 37: 641-650
        • Moozar K.L.
        • Wong C.S.
        • Couture J.
        Anorectal malignant melanoma: treatment with surgery or radiation therapy, or both.
        Can J Surg. 2003; 46: 345-349
        • Ugurel S.
        • Hildenbrand R.
        • Zimpfer A.
        • et al.
        Lack of clinical efficacy of imatinib in metastatic melanoma.
        Br J Cancer. 2005; 92: 1398-1405
        • Lutzky J.
        New therapeutic options in the medical management of advanced melanoma.
        Semin Cutan Med Surg. 2010; 29: 249-257
        • Hodi F.S.
        • O'Day S.J.
        • McDermott D.F.
        • et al.
        Improved survival with ipilimumab in patients with metastatic melanoma.
        N Engl J Med. 2010; 363: 711-723
        • Kanda Y.
        Investigation of the freely available easy-to-use software 'EZR' for medical statistics.
        Bone Marrow Transplant. 2013; 48: 452-458
        • Chen H.
        • Cai Y.
        • Liu Y.
        • et al.
        Incidence, surgical treatment, and prognosis of anorectal melanoma from 1973 to 2011: a population-based SEER analysis.
        Medicine (Baltim). 2016; 95e2770
        • Menon H.
        • Patel R.R.
        • Cushman T.R.
        • et al.
        Management and outcomes of primary anorectal melanoma in the United States.
        Future Oncol. 2020; 16: 329-338
        • Taylor J.P.
        • Stem M.
        • Yu D.
        • et al.
        Treatment strategies and survival trends for anorectal melanoma: is it time for a change?.
        World J Surg. 2019; 43: 1809-1819
        • Bello D.M.
        • Smyth E.
        • Perez D.
        • et al.
        Anal versus rectal melanoma: does site of origin predict outcome?.
        Dis Colon Rectum. 2013; 56: 150-157
      1. Cancer stat facts: melanoma of the skin. National cancer Institute.
        (Available at)
        • Bhatia S.
        • Tykodi S.S.
        • Thompson J.A.
        Treatment of metastatic melanoma: an overview.
        Oncology (Williston Park). 2009; 23: 488-496
        • Larkin J.
        • Chiarion-Sileni V.
        • Gonzalez R.
        • et al.
        Combined nivolumab and ipilimumab or monotherapy in untreated melanoma.
        N Engl J Med. 2015; 373: 23-34
        • Chapman P.B.
        • Hauschild A.
        • Robert C.
        • et al.
        Improved survival with vemurafenib in melanoma with BRAF V600E mutation.
        N Engl J Med. 2011; 364: 2507-2516
        • Cui C.
        • Lian B.
        • Zhang X.
        • Wu D.
        • Li K.
        • Si L.
        • et al.
        An evidence-based staging system for mucosal melanoma: a proposal.
        Ann Surg Oncol. 2022 Aug; 29: 5221-5234https://doi.org/10.1245/s10434-022-11670-6