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Biological Factors, Tumor Growth Kinetics, and Survival After Metastasectomy for Pulmonary Melanoma

  • Melanomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Introduction

Approximately 23% of melanoma patients will eventually develop pulmonary metastases and have a median survival of only about 7–11 months. Because pulmonary metastasectomy can improve this statistic, we investigated clinicopathologic features and biological correlates that might be used to identify surgical candidates.

Methods

Archived operative specimens and clinical records were retrieved for 20 melanoma patients who underwent resection of isolated pulmonary metastases at the John Wayne Cancer Institute, Saint John’s Health Center. Five-year postmetastasectomy survival (PMS) rate was correlated with age, number of pulmonary metastases, tumor doubling time (TDT), tumor necrosis, and immunohistochemical expressions of four biological markers: Ki-67, glucose transporter-1 (Glut-1), caspase-3, and CD31.

Results

Median TDT was 61 days. On multivariate analysis, TDT (P = 0.008), Glut-1 intensity (P = 0.04), and CD31 expression (P = 0.004) were the significant predictors of PMS. Age, number of pulmonary metastases, tumor necrosis, and expression of Ki-67 or caspase-3 did not significantly impact survival. Median TDT was 56 days with Glut-1 expression versus 165 days without Glut-1 expression (P = 0.002), and Glut-1 staining intensity independently affected TDT (P = 0.012).

Conclusions

Surgical resection may be preferable to toxic systemic therapies in melanoma patients whose isolated pulmonary metastases have a long TDT (≥61 days) and no biopsy evidence of Glut-1 expression.

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Acknowledgment

Supported by grants P01 CA29605 and P01 CA12582 from the National Cancer Institute and by funding from the Wayne and Gladys Valley Foundation (Oakland, CA), the Amyx Foundation, Inc. (Boise, ID), Berton M. Kirshner (Los Angeles, CA), Todd Kirshner (Los Angeles, CA), Mr. and Mrs. Louis Johnson (Stanfield, AZ), Heather and Jim Murren (Las Vegas, NV), Mrs. Marianne Reis (Lake Forest, CA), the Wallis Foundation (Los Angeles, CA), Dr. Miriam & Sheldon G. Adelson Medical Research Foundation (Santa Monica, CA), and the Lincy Foundation (Beverly Hills, CA).

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Authors and Affiliations

  1. Division of Surgical Oncology, John Wayne Cancer Institute at Saint John’s Health Center, Santa Monica, CA, USA

    Jonathan H. Lee MD, Seza A. Gulec MD & Donald L. Morton MD

  2. Department of Surgery, Division of Surgical Oncology, UMDNJ/RWJ Medical School, The Cancer Institute of New Jersey, New Brunswick, NJ, USA

    Jonathan H. Lee MD

  3. Department of Surgery, Florida International University College of Medicine, Miami, FL, USA

    Seza A. Gulec MD

  4. Clarient Diagnostic Services, Aliso Viejo, CA, USA

    Ainura Kyshtoobayeva MD, PhD

  5. Department of Biostatistics, John Wayne Cancer Institute, Santa Monica, CA, USA

    Myung-Shin Sim DrPH

Authors
  1. Jonathan H. Lee MD
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  2. Seza A. Gulec MD
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  3. Ainura Kyshtoobayeva MD, PhD
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  5. Donald L. Morton MD
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Correspondence to Jonathan H. Lee MD.

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Lee, J.H., Gulec, S.A., Kyshtoobayeva, A. et al. Biological Factors, Tumor Growth Kinetics, and Survival After Metastasectomy for Pulmonary Melanoma. Ann Surg Oncol 16, 2834–2839 (2009). https://doi.org/10.1245/s10434-009-0583-5

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  • DOI: https://doi.org/10.1245/s10434-009-0583-5

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