Melanoma Cutáneo Etapa clínica IIIB-D: análisis retrospectivo de pacientes tratados en el Instituto Oncológico Nacional de Panamá
[Cutaneous Melanoma Clinical Stage IIIB-D: Retrospective analysis of patients treated at the National Oncology Institute of Panama.]David Espinosa1
, Marco Achurra1 , Patsy Moreno2 1. Departamento de Cirugía Oncológica, Instituto Oncológico Nacional, Panamá, Rep de Panamá; 2. Hospital Dr Gustavo Nelson Collado, Chitré, Rep de Panamá;
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Resumen
Antecedentes y objetivos: El melanoma cutáneo es una enfermedad agresiva. Aproximadamente el 10% de los casos son diagnosticados con enfermedad regional, siendo el manejo estándar, la resección del primario con linfadenectomía regional con inmunoterapia adyuvante o neoadyuvante. El objetivo de este estudio es reportar los resultados oncológicos en este grupo de pacientes y establecer factores asociados a mayor recurrencia y mortalidad. Materiales y métodos: Descriptivo, no experimental, transversal y retrospectivo. Se analizaron 44 pacientes con diagnóstico Melanoma cutáneo ECIIIB-D tratados en el Instituto Oncológico Nacional durante el período de enero 2017 a diciembre 2023. Resultados: 44 pacientes fueron tratados. El 49.5% con Breslow > 4 mm y 68.2% con ulceración, el 75% presentaban ≥2 ganglios positivos. La mediana de supervivencia global fue 30 meses y la mediana de supervivencia libre de recurrencia 12 meses. Los pacientes con recurrencia tuvieron peor mediana de supervivencia global (25 meses) que los que no tuvieron recurrencia (no alcanzada) (p 0.036). Los factores de riesgo asociados a mayor recurrencia fueron Breslow 2.1-4 mm (HR 4.88, IC 1.0-23.01, p 0.046) y ≥4 ganglios positivos (HR 4.2, IC 1.17-15.2, p 0.027). La ausencia de invasión linfovascular fue factor protector de muerte (HR 0.21, IC 0.06-0.67, p 0.008). Conclusiones: en el Instituto Oncológico Nacional, la supervivencia libre de recurrencia es ligeramente más baja que en la literatura mundial, los principales factores asociados a recurrencia fueron Breslow > 2 mm y ≥4 o más ganglios positivos. Esto crea la pregunta de si agregar inmunoterapia podría mejorar estos resultados.
Abstract
Background and Objectives: Cutaneous melanoma is an aggressive disease. Approximately 10% of cases are diagnosed with regional disease, with the standard management being primary resection with regional lymphadenectomy with adjuvant or neoadjuvant immunotherapy. The aim of this study is to report the oncological outcomes in this group of patients and establish factors associated with increased recurrence and mortality. Materials and Methods: Descriptive, non-experimental, cross-sectional, and retrospective. 44 patients with stage IIIB-D cutaneous melanoma diagnosed were analyzed at the National Oncology Institute during the period from January 2017 to December 2023. Results: 44 patients were treated. 49.5% had Breslow thickness > 4 mm and 68.2% had ulceration, 75% had ≥2 positive nodes. The median overall survival was 30 months and the median recurrence-free survival was 12 months. Patients with recurrence had worse median overall survival (25 months) than those without recurrence (not reached) (p 0.036). Risk factors associated with increased recurrence were Breslow 2.1-4 mm (HR 4.88, CI 1.0-23.01, p 0.046) and ≥4 positive nodes (HR 4.2, CI 1.17-15.2, p 0.027). Absence of lymphovascular invasion was a protective factor for death (HR 0.21, CI 0.06-0.67, p 0.008). Conclusions: At the National Oncology Institute, recurrence-free survival is slightly lower than in the global literature, the main factors associated with recurrence were Breslow > 2 mm and ≥4 or more positive nodes. This raises the question of whether adding immunotherapy could improve these results.
Citas
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