Laryngoscope. 2021 Aug 06; doi: 10.1002/lary.29807. Epub 2021 Aug 06.
Adjuvant Therapy and Prognosticators of Survival in Head and Neck Mucosal Melanoma.
The Laryngoscope
Arash Abiri, Tyler M Yasaka, Brandon M Lehrich, Khodayar Goshtasbi, Peter Papagiannopoulos, Bobby A Tajudeen, Maie A St John, Jeremy P Harris, Edward C Kuan
Affiliations
Affiliations
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, U.S.A.
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
- Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, California, U.S.A.
- Department of Radiation Oncology, University of California, Irvine, California, U.S.A.
PMID: 34355791
DOI: 10.1002/lary.29807
Abstract
OBJECTIVES/HYPOTHESIS: To identify prognosticators and determine the efficacies of surgery with adjuvant radiotherapy (SR) and surgery with immunotherapy (SI) of head and neck mucosal melanoma (HNMM).
STUDY DESIGN: Retrospective database study.
METHODS: The 2004 to 2017 National Cancer Database was queried for HNMM patients. Cox proportional hazards and Kaplan-Meier analyses evaluated prognosticators of mortality and survival benefits conferred by SR, SI, or surgery with adjuvant radiotherapy and immunotherapy (SRI). Logistic regression identified predictors of adjuvant radiotherapy or immunotherapy use.
RESULTS: Overall, 1,910 cases (845 surgery, 802 SR, 51 SI, 101 SRI) were analyzed, with 50.3% females and an average age of 68.6 ± 13.8 years. SI was associated with greater overall survival (OS) than surgery (hazard ratio [HR] 0.672; P = .036). SI (HR 0.425; P = .024) and SRI (HR 0.594; P = .045) were associated with superior OS than SR. Older age (HR 1.607; P < .001), female sex (HR 0.757; P = .006), paranasal sinus localization (HR 1.648; P < .001), T4 classification (HR 1.443; P < .001), N1 classification (HR 2.310; P < .001), M1 classification (HR 3.357; P < .001), and positive surgical margins (HR 1.454; P < .001) were survival prognosticators. Adjuvant radiotherapy use was negatively correlated with older age, oral cavity localization, and M0 or T3 tumors (all P < .05). Adjuvant immunotherapy use was positively correlated with younger age and M1 tumors (all P < .05).
CONCLUSIONS: Although SR did not confer survival benefits in HNMM patients, SI and SRI yielded greater OS than surgery alone. SRI was associated with superior survival outcomes than SR. Certain demographic and clinical factors were associated with increased mortality risk. Patient age and certain tumor characteristics were predictors of adjuvant radiotherapy or immunotherapy use.
LEVEL OF EVIDENCE: 4 Laryngoscope, 2021.
© 2021 The American Laryngological, Rhinological and Otological Society, Inc.
Keywords: Mucosal melanoma; head and neck; immunotherapy; radiation therapy; survival outcomes
References
- Ascierto PA, Accorona R, Botti G, et al. Mucosal melanoma of the head and neck. Crit Rev Oncol Hematol 2017;112:136-152. - PubMed
- Green B, Elhamshary A, Gomez R, Rahimi S, Brennan PA. An update on the current management of head and neck mucosal melanoma. J Oral Pathol Med 2017;46:475-479. - PubMed
- Marcus DM, Marcus RP, Prabhu RS, et al. Rising incidence of mucosal melanoma of the head and neck in the United States. J Skin Cancer 2012;2012:231693. - PubMed
- Jangard M, Hansson J, Ragnarsson-Olding B. Primary sinonasal malignant melanoma: a nationwide study of the Swedish population, 1960-2000. Rhinology 2013;51:22-30. - PubMed
- Lopez F, Rodrigo JP, Cardesa A, et al. Update on primary head and neck mucosal melanoma. Head Neck 2016;38:147-155. - PubMed
- Plavc G, But-Hadzic J, Anicin A, Lanisnik B, Didanovic V, Strojan P. Mucosal melanoma of the head and neck: a population-based study from Slovenia, 1985-2013. Radiat Oncol 2016;11:137. - PubMed
- Lourenco SV, Fernandes JD, Hsieh R, et al. Head and neck mucosal melanoma: a review. Am J Dermatopathol 2014;36:578-587. - PubMed
- Gilain L, Houette A, Montalban A, Mom T, Saroul N. Mucosal melanoma of the nasal cavity and paranasal sinuses. Eur Ann Otorhinolaryngol Head Neck Dis 2014;131:365-369. - PubMed
- Mendenhall WM, Amdur RJ, Hinerman RW, Werning JW, Villaret DB, Mendenhall NP. Head and neck mucosal melanoma. Am J Clin Oncol 2005;28:626-630. - PubMed
- Konuthula N, Khan MN, Parasher A, et al. The presentation and outcomes of mucosal melanoma in 695 patients. Int Forum Allergy Rhinol 2017;7:99-105. - PubMed
- Schmidt MQ, David J, Yoshida EJ, et al. Predictors of survival in head and neck mucosal melanoma. Oral Oncol 2017;73:36-42. - PubMed
- Sun S, Huang X, Gao L, et al. Long-term treatment outcomes and prognosis of mucosal melanoma of the head and neck: 161 cases from a single institution. Oral Oncol 2017;74:115-122. - PubMed
- Li W, Yu Y, Wang H, Yan A, Jiang X. Evaluation of the prognostic impact of postoperative adjuvant radiotherapy on head and neck mucosal melanoma: a meta-analysis. BMC Cancer 2015;15:758. - PubMed
- Krengli M, Jereczek-Fossa BA, Kaanders JH, Masini L, Beldi D, Orecchia R. What is the role of radiotherapy in the treatment of mucosal melanoma of the head and neck? Crit Rev Oncol Hematol 2008;65:121-128. - PubMed
- Tyrrell H, Payne M. Combatting mucosal melanoma: recent advances and future perspectives. Melanoma Manag 2018;5:MMT11. - PubMed
- D'Angelo SP, Larkin J, Sosman JA, et al. Efficacy and safety of nivolumab alone or in combination with ipilimumab in patients with mucosal melanoma: a pooled analysis. J Clin Oncol 2017;35:226-235. - PubMed
- Ganti A, Raman A, Shay A, et al. Treatment modalities in sinonasal mucosal melanoma: A national cancer database analysis. Laryngoscope 2019;130:275-282. - PubMed
- Winchester DP, Stewart AK, Bura C, Jones RS. The National Cancer Data Base: a clinical surveillance and quality improvement tool. J Surg Oncol 2004;85:1-3. - PubMed
- R Core Team Version 3.5.2. Vienna, Austria: R Foundation for Statistical Computing; 2018. - PubMed
- RStudio Team Version 1.1.463. Boston, MA: RStudio, Inc; 2016. - PubMed
- Amit M, Na'ara S, Hanna EY. Contemporary treatment approaches to sinonasal mucosal melanoma. Curr Oncol Rep 2018;20:10. - PubMed
- Amit M, Tam S, Abdelmeguid AS, et al. Role of adjuvant treatment in SINONASAL mucosal melanoma. J Neurol Surg B Skull Base 2017;78:512-518. - PubMed
- Amaria RN, Reddy SM, Tawbi HA, et al. Neoadjuvant immune checkpoint blockade in high-risk resectable melanoma. Nat Med 2018;24:1649-1654. - PubMed
- Kaufman HL, Kirkwood JM, Hodi FS, et al. The Society for Immunotherapy of Cancer consensus statement on tumour immunotherapy for the treatment of cutaneous melanoma. Nat Rev Clin Oncol 2013;10:588-598. - PubMed
- O'Reilly A, Larkin J. Checkpoint inhibitors in advanced melanoma: effect on the field of immunotherapy. Expert Rev Anticancer Ther 2017;17:647-655. - PubMed
- Amit M, Hanna EY. ASO author reflections: treatment approaches to sinonasal mucosal melanoma. Ann Surg Oncol 2018;25:890-891. - PubMed
- Rausch MP, Hastings KT. Immune checkpoint inhibitors in the treatment of melanoma: from basic science to clinical application. In: Ward WH, Farma JM, eds. Cutaneous Melanoma: Etiology and Therapy. Brisbane, Australia: Codon Publications; 2017. - PubMed
- Amit M, Tam S, Abdelmeguid AS, et al. Mutation status among patients with sinonasal mucosal melanoma and its impact on survival. Br J Cancer 2017;116:1564-1571. - PubMed
- Ren Y, Lv Q, Yue W, Liu B, Zou Z. The programmed cell death protein-1/programmed cell death ligand 1 expression, CD3+ T cell infiltration, NY-ESO-1 expression, and microsatellite instability phenotype in primary cutaneous melanoma and mucosal melanoma and their clinical significance and prognostic value: a study of 89 consecutive cases. Melanoma Res 2020;30:85-101. - PubMed
- Yentz S, Lao CD. Immunotherapy for mucosal melanoma. Ann Transl Med 2019;7:S118. - PubMed
- Dreno M, Georges M, Espitalier F, et al. Sinonasal mucosal melanoma: a 44-case study and literature analysis. Eur Ann Otorhinolaryngol Head Neck Dis 2017;134:237-242. - PubMed
- Meerwein CM, Hullner M, Braun R, Soyka MB, Morand GB, Holzmann D. Current concepts in advanced sinonasal mucosal melanoma: a single institution experience. Eur Arch Otorhinolaryngol 2019;276:2259-2265. - PubMed
- Moya-Plana A, Herrera Gomez RG, Rossoni C, et al. Evaluation of the efficacy of immunotherapy for non-resectable mucosal melanoma. Cancer Immunol Immunother 2019;68:1171-1178. - PubMed
- Chao TN, Kuan EC, Tong CCL, et al. Surgical treatment of sinonasal mucosal melanoma in patients treated with systemic immunotherapy. J Neurol Surg B Skull Base 2020;82:e148-e154. - PubMed
- Mignard C, Deschamps Huvier A, Gillibert A, et al. Efficacy of immunotherapy in patients with metastatic mucosal or uveal melanoma. J Oncol 2018;2018:1908065. - PubMed
- Manton T, Tillman B, McHugh J, Bellile E, McLean S, McKean E. Sinonasal melanoma: a single institutional analysis and future directions. J Neurol Surg B Skull Base 2019;80:484-492. - PubMed
- Owens JM, Roberts DB, Myers JN. The role of postoperative adjuvant radiation therapy in the treatment of mucosal melanomas of the head and neck region. Arch Otolaryngol Head Neck Surg 2003;129:864-868. - PubMed
- Temam S, Mamelle G, Marandas P, et al. Postoperative radiotherapy for primary mucosal melanoma of the head and neck. Cancer 2005;103:313-319. - PubMed
- Benlyazid A, Thariat J, Temam S, et al. Postoperative radiotherapy in head and neck mucosal melanoma: a GETTEC study. Arch Otolaryngol Head Neck Surg 2010;136:1219-1225. - PubMed
- Chan RC, Chan JY, Wei WI. Mucosal melanoma of the head and neck: 32-year experience in a tertiary referral hospital. Laryngoscope 2012;122:2749-2753. - PubMed
- Patel SG, Prasad ML, Escrig M, et al. Primary mucosal malignant melanoma of the head and neck. Head Neck 2002;24:247-257. - PubMed
- Saigal K, Weed DT, Reis IM, Markoe AM, Wolfson AH, Nguyen-Sperry J. Mucosal melanomas of the head and neck: the role of postoperative radiation therapy. ISRN Oncol 2012;2012:785131. - PubMed
- Moreno MA, Roberts DB, Kupferman ME, et al. Mucosal melanoma of the nose and paranasal sinuses, a contemporary experience from the M. D. Anderson cancer center. Cancer 2010;116:2215-2223. - PubMed
- Michel J, Perret-Court A, Fakhry N, et al. Sinonasal mucosal melanomas: the prognostic value of tumor classifications. Head Neck 2014;36:311-316. - PubMed
- Williams MD. Update from the 4th edition of the World Health Organization classification of head and neck Tumours: mucosal melanomas. Head Neck Pathol 2017;11:110-117. - PubMed
- Jethanamest D, Vila PM, Sikora AG, Morris LG. Predictors of survival in mucosal melanoma of the head and neck. Ann Surg Oncol 2011;18:2748-2756. - PubMed
- Roth TN, Gengler C, Huber GF, Holzmann D. Outcome of sinonasal melanoma: clinical experience and review of the literature. Head Neck 2010;32:1385-1392. - PubMed
- Amit M, Tam S, Abdelmeguid AS, et al. Patterns of treatment failure in patients with sinonasal mucosal melanoma. Ann Surg Oncol 2018;25:1723-1729. - PubMed
- Bachar G, Loh KS, O'Sullivan B, et al. Mucosal melanomas of the head and neck: experience of the Princess Margaret Hospital. Head Neck 2008;30:1325-1331. - PubMed
- Sayed Z, Migliacci JC, Cracchiolo JR, et al. Association of surgical approach and margin status with oncologic outcomes following gross total resection for sinonasal melanoma. JAMA Otolaryngol Head Neck Surg 2017;143:1220-1227. - PubMed
Publication Types
Grant support