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. 2025 Jan 10;17(2):206.
doi: 10.3390/cancers17020206.

The Role of Metastasectomies and Immunotherapy in the Management of Melanoma Lung Metastases: An Analysis of the National Cancer Database

Panagiotis Tasoudis  1 , Vasiliki Manaki  2 , Shannon Parness  1 , Audrey L Khoury  1 , Chris B Agala  3 , Benjamin E Haithcock  1 , Gita N Mody  1 , Jason M Long  1
Affiliations

The Role of Metastasectomies and Immunotherapy in the Management of Melanoma Lung Metastases: An Analysis of the National Cancer Database

Panagiotis Tasoudis et al. Cancers (Basel). .

Abstract

Introduction: Patients with metastatic melanoma to the lung typically have poor outcomes. Although a pulmonary metastasectomy for selected patients has been shown to improve survival, the role of surgical resection following the introduction of immunotherapy for metastatic melanoma is unknown. The objective of this study was to determine predictors of survival for patients with melanoma metastatic to the lung in the era of immunotherapy.

Methods: In this retrospective study, data from the National Cancer Database were abstracted for patients with melanoma lung metastases. The overall survival was evaluated using Kaplan-Meier and Cox proportional hazard analysis, adjusting for previously described risk factors for mortality. Patients with concomitant metastases to organs other than the lung were excluded from the study.

Results: A total of 625 patients with lung metastases at the time of a skin melanoma diagnosis were identified. A total of 280 patients underwent a pulmonary metastasectomy, 267 received immunotherapy, and 78 were treated with both a metastasectomy and immunotherapy. During a median follow-up time of 34.6 months [IQR: 14.2, 75.9], a metastasectomy was found to offer significantly improved survival compared to immunotherapy alone. No difference was noted between a metastasectomy and a combination of a metastasectomy and immunotherapy in the adjusted Cox proportional hazard model.

Conclusions: When statistical models were adjusted for risk factors, a metastasectomy maintained a significant survival advantage compared to immunotherapy. The addition of immunotherapy to the treatment of patients treated with a pulmonary metastasectomy did not improve survival. Our findings support the role of surgery for patients with pulmonary metastatic melanoma.

Keywords: immunotherapy; melanoma lung metastasis; metastasectomy.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Unadjusted Cox proportional hazards model measuring overall survival within each treatment group.
Figure 2
Figure 2
Adjusted Kaplan–Meier curves for age, Charlson–Deyo score, and treatment center location for overall survival within each treatment group.
See this image and copyright information in PMC

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