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

James P. Taylor, Miloslawa Stem, David Yu, Sophia Y. Chen, Sandy H Fang, Susan L Gearhart, Bashar Safar, Jonathan Efron

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalWorld journal of surgery
DOIs
StatePublished - Jan 1 2019

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Immunotherapy
Melanoma
Survival
Therapeutics
Medicare
Logistic Models
Databases
Radiation
Drug Therapy
Skin
Neoplasms

ASJC Scopus subject areas

  • Surgery

Cite this

Treatment Strategies and Survival Trends for Anorectal Melanoma : Is it Time for a Change? / Taylor, James P.; Stem, Miloslawa; Yu, David; Chen, Sophia Y.; Fang, Sandy H; Gearhart, Susan L; Safar, Bashar; Efron, Jonathan.

In: World journal of surgery, 01.01.2019.

Research output: Contribution to journalArticle

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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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AU - Fang, Sandy H

AU - Gearhart, Susan L

AU - Safar, Bashar

AU - Efron, Jonathan

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