Abstract
OBJECTIVE
Metastatic melanoma has a poor prognosis. This study aimed to develop and validate era-specific nomograms for Stage IV (M1a-c) melanoma and assess the survival impact of surgery across two eras.
METHODS
This retrospective Surveillance, Epidemiology, and End Results (SEER) study included 3,319 stage IV melanoma patients divided into pre-immunotherapy era (2001-2005, n  = 622) and early immunotherapy era (2011-2015, n  = 2,697) cohorts. Cox regression identified overall survival (OS) prognostic factors. Era-specific nomograms predicting 1-, 3-, and 5-year OS were constructed and validated. The survival benefit of surgery was assessed using Kaplan-Meier analysis.
RESULTS
Age, M-stage, lactate dehydrogenase, chemotherapy, and surgery were consistent independent prognostic factors in both eras. The nomograms showed good calibration yet limited discriminatory capacity only slightly exceeding the 0.5 random threshold (C-index: 0.649 and 0.641 for pre- and early immunotherapy eras, respectively). Surgery showed longer OS in patients of the overall immunotherapy cohort: median OS was 17 vs. 6 months for surgical vs. non-surgical patients ( p   p   p   p  < 0.001).
CONCLUSIONS
We constructed population-based era-specific nomograms for stage IV melanoma. Within the immunotherapy cohort, surgery correlates with prolonged survival, suggesting surgical evaluation for selected metastatic melanoma patients.