Trends in surgical treatment of stage IV melanoma: A SEER database study
Bibliographic record
Abstract
Introduction: Immunotherapy for advanced melanoma has improved survival outcomes and changed the surgical management of this disease. Prior work demonstrated no difference in rates of resection for stage IV melanoma after the introduction of immunotherapy. However, prior data were limited by shorter study durations and by only examining distant resections. As such, we sought to expand this work by examining longitudinal trends in both primary and distant resections for patients with advanced melanoma in the years after immunotherapy approvals. Methods: This retrospective cohort study used the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database to capture adult patients diagnosed with stage IV cutaneous melanoma between 2004 and 2020. We identified the annual percentage of patients who underwent surgical resections. Results: Of the 10,632 case records included, significantly fewer patients underwent surgical resection in the post-immunotherapy era (2011-2020) as compared to the pre-immunotherapy era (2004-2013) (50.4 % vs. 59.6 %, p < 0.0001). In our interrupted time series, we found a significant decline in the rate of all surgical resections in the post-immunotherapy era, decreasing by 0.97 % per year (p < 0.0001). There were significant decreases in the rates of both primary and distant resections in the post-immunotherapy era. For primary resections alone, we observed a significant level of change with annual rates of surgery declining by 5.1 % (p = 0.014) after 2011. Conclusions: This study confirms that a significant - albeit declining - proportion of patients with stage IV melanoma undergo both primary and distant resections in the post-immunotherapy era. Synopsis: Since the initial approval of immunotherapy to treat advanced melanoma in 2011, the role of surgical care for melanoma has evolved. This study examined trends in the utilization of surgery for patients with stage IV melanoma before and after 2011. We identified patients diagnosed with stage IV melanoma between 2004 and 2020 (N = 10,632) from the Surveillance, Epidemiology, and End Results database. Using an interrupted time series analysis, we compared the proportion of patients who underwent either primary or distant surgical resections in the pre- and post-immunotherapy eras (59.6 % vs. 50.4 %, respectively; p < 0.0001). There was a significant decline in the rate of all surgical resections in the post-immunotherapy era, decreasing by 0.97 % per year (p < 0.0001). These results highlight diminishing but still robust surgical treatment of stage IV melanoma since the introduction of immunotherapy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".