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04.03.2019 | Original Scientific Report | Ausgabe 7/2019

World Journal of Surgery 7/2019

Treatment Strategies and Survival Trends for Anorectal Melanoma: Is it Time for a Change?

Zeitschrift:
World Journal of Surgery > Ausgabe 7/2019
Autoren:
James P. Taylor, Miloslawa Stem, David Yu, Sophia Y. Chen, Sandy H. Fang, Susan L. Gearhart, Bashar Safar, Jonathan E. Efron
Wichtige Hinweise
Meetings: Poster presentations at ASCRS, Nashville May 19–23 2018 and at the Canadian Association of General Surgeons, St John September 13–15. Podium presentation at International Society of University Colon and Rectal Surgeons, London August 29th–September 1st 2018.
Disclaimers: The National Cancer Data Base (NCDB) is a joint project of the Commission on Cancer (CoC) of the American College of Surgeons and the American Cancer Society. The CoC’s NCDB and the hospitals participating in the CoC NCDB are the source of the de-identified data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

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Abstract

Background

Immunotherapy advances for the treatment of cutaneous melanoma question its efficacy in treating anorectal mucosal melanoma (ARMM). We aimed to identify the prevalence, current management, and overall survival (OS) for ARMM.

Methods

Review of patients with ARMM from 2004 to 2015 National Cancer Database. Factors associated with immunotherapy were identified using multivariable logistic regression. The primary outcome was 2- and 5-year OS. Subgroup analysis by treatment type was performed.

Results

A total of 1331 patients were identified with a significant increase in prevalence (2004: 6.99%, 2015: 10.53%). ARMM patients were older, white, on Medicare, and from the South. The most common treatment was surgery (48.77%), followed by surgery + radiation (11.75%), surgery + immunotherapy (8.68%), and surgery + chemotherapy (8.68%). 16.93% of patients received immunotherapy, with utilization increasing (7.24%: 2004, 21.27%: 2015, p < 0.001). Patients who received immunotherapy had a significantly better 2-year OS (42.47% vs. 49.21%, p < 0.001), and other therapies did not reveal a significant difference. Adjusted analysis showed no difference in 2- and 5-year OS based on therapy type.

Conclusion

The prevalence of ARMM has increased. The use of immunotherapy has increased substantially. Some survival benefit with the administration of immunotherapy may exist that has yet to be revealed. A more aggressive treatment paradigm is warranted.

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