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

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 i...

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Published in:Annals of surgical oncology 2020-10, Vol.27 (10), p.3683-3691
Main Authors: Ibrahim, Andrea Marie, Le May, Melanie, Bossé, Dominick, Marginean, Horia, Song, Xinni, Nessim, Carolyn, Ong, Michael
Format: Article
Language:English
Subjects:
Brain Neoplasms - diagnostic imaging
Brain Neoplasms - mortality
Brain Neoplasms - secondary
Brain Neoplasms - therapy
Humans
Medicine
Medicine & Public Health
Melanoma
Melanoma - diagnostic imaging
Melanoma - drug therapy
Melanoma - mortality
Melanoma - surgery
Neoplasm Recurrence, Local - diagnostic imaging
Neoplasm Recurrence, Local - drug therapy
Neoplasm Recurrence, Local - mortality
Neoplasm Recurrence, Local - surgery
Oncology
Retrospective Studies
Skin Neoplasms - diagnostic imaging
Skin Neoplasms - drug therapy
Skin Neoplasms - mortality
Skin Neoplasms - surgery
Surgery
Surgical Oncology
Survival Rate
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Summary: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  
ISSN:1068-9265
1534-4681
DOI:10.1245/s10434-020-08407-8