Survival impact of post-operative immunotherapy in resected stage III cutaneous melanomas in the checkpoint era

Q: Which patients were included and how was treatment timing defined?

Patients with stage III cutaneous melanoma diagnosed from 2016 to 2019 who underwent definitive resection were included. Post-operative immunotherapy was defined as receipt within 84 days of surgery.

Q: How many patients received post-operative immunotherapy, and what comparison group was used?

Out of 14,978 patients, 34.9% (n=5,234) received post-operative immunotherapy and 65.1% (n=9,744) did not. Overall survival was compared between these groups.

Q: Did post-operative immunotherapy improve 36-month survival across all AJCCv8 stage III substages?

Yes for AJCCv8 stage IIIB, IIIC, and IIID, where 36-month survival was significantly higher with post-operative immunotherapy. No significant improvement was observed for stage IIIA.

Sep 22, 2026

Upload by Lucas Martin

Checkpoint inhibitors improved recurrence-free survival after surgery for node-positive melanoma, yet overall survival benefits for lower-risk stage III disease remained uncertain. This study used real-world National Cancer Database data to compare overall survival in patients with resected stage III cutaneous melanoma who received post-operative immunotherapy within 84 days versus those who did not. Kaplan–Meier and Cox models assessed survival differences across AJCCv8 substages.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Background

Patients and methods

Data source

Study design and analysis

Results

Overall survival by AJCCv8 substage

Conclusions

Key words

ORIGINAL RESEARCH Survival impact of post-operative immunotherapy in resected stage III cutaneous melanomas in the checkpoint era G. Hagopian1y, X. Jiang2y, C. Grant1y, D. Brazel1, P. Kumar1, M. Yamamoto3, J. Jakowatz3, W. Chow4, T. Tran3, W. Shen2 & J. Moyers5􀀂z 1Department of Medicine, University of California Irvine Medical Center, Orange; 2Department of Statistics, University of California Irvine, Irvine; 3Division of Surgical Oncology, Department of Surgery, University of California Irvine Medical Center, Orange; 4Division of Hematology and Oncology, Department of Medicine, University of California Irvine Medical Center, Orange; 5The Angeles Clinic & Research Institute, A Cedars-Sinai Afﬁliate, Los Angeles, USA Available online 24 January 2024 Background: Checkpoint inhibitors have shown improvement in recurrence-free survival in the post-operative setting for node-positive melanoma and were ﬁrst approved in late 2015 . However, single-agent checkpoint therapies have yet to show beneﬁt to overall survival (OS) for lower-risk stage III cancers. We evaluated the OS beneﬁt of post-operative immunotherapy in the National Cancer Database (NCDB) . Patients and methods: Patient cases were selected from the NCDB 2020 Participant Use File. Patients diagnosed with stage III cutaneous melanoma between 2016 and 2019 who underwent deﬁnitive resection for their melanoma were included. OS between those who received post-operative immunotherapy within 84 days of surgery and those who did not was analyzed by the KaplaneMeier method. Demographic and clinical characteristics between the two groups were compared via Cox proportional hazard models. Results: 14 978 patients with stage III melanoma were included. Of those, 34 .9%(n ¼ 5234) received post-operative immunotherapy and 65 . 1%(n ¼ 9744) did not. Using the American Joint Committee on Cancer version 8 (AJCCv8) staging, 36-month survival was signiﬁcantly higher in patients who received post-operative immunotherapy compared to no post-operative systemic therapy in those diagnosed with stage IIIB (88 .0% versus 84 .7%, P ¼ 0.011), IIIC (75 .6% versus 68 . 1%, P < 0.001), or IIID (59 . 2% versus 48 .4%, P ¼ 0.002) . No signiﬁcant improvement in 36-month survival was seen in patients who received post-operative immunotherapy in patients with stage IIIA disease (93 .0% versus 92 . 2%, P ¼ 0. 218) . Conclusions: Post-operative immunotherapy had an OS beneﬁt in patients with AJCCv8 stage IIIB, IIIC, and IIID disease, but had no signiﬁcant survival beneﬁt for patients with stage IIIA melanomas. Key words: immunotherapy, melanoma, adjuvant immunotherapy INTRODUCTION Approximately 9% of the 97 610 cases of cutaneous melanomas diagnosed in the United States in 2023 will have regional disease at diagnosis.1 Stage III cutaneous melanoma outcomes are heterogenous and largely dependent upon substage. In the American Joint Committee on Cancer (AJCC) version 8 staging system, stage IIIA melanoma has a high cure rate with a 93% melanoma-speciﬁc survival at 5 *Correspondence to: Dr Justin T. Moyers, The Angeles Clinic & Research Institute, A Cedars-Sinai Afﬁliate, 11800 Wilshire Boulevard, Los Angeles, CA 90025, USA. Tel: þ1-310-231-2127; Fax: þ1-310-231-2172 E-mail: [jmoyers@theangelesclinic.org](jmoyers@theangelesclinic.org) (J. Moyers). yContributed equally. zPrevious address: Division of Hematology and Oncology, Department of Medicine, University of California Irvine Medical Center, Orange, USA 2059-7029/© 2023 The Author(s). Published by Elsevier Ltd on behalf of European Society for Medical Oncology. This is an open access article under the CC BY-NC-ND license ([http://creativecommons.org/licenses/by-nc-nd/4.0/](http://creativecommons.org/licenses/by-nc-nd/4.0/)). years; however, higher-risk stage IIIC and IIID disease have a 5-year melanoma-speciﬁc survival of only 69% and 32%, respectively.2 Before the checkpoint era, adjuvant options following surgery included

FAQs

Which patients were included and how was treatment timing defined?

Patients with stage III cutaneous melanoma diagnosed from 2016 to 2019 who underwent definitive resection were included. Post-operative immunotherapy was defined as receipt within 84 days of surgery.

How many patients received post-operative immunotherapy, and what comparison group was used?

Out of 14,978 patients, 34.9% (n=5,234) received post-operative immunotherapy and 65.1% (n=9,744) did not. Overall survival was compared between these groups.

Did post-operative immunotherapy improve 36-month survival across all AJCCv8 stage III substages?

Yes for AJCCv8 stage IIIB, IIIC, and IIID, where 36-month survival was significantly higher with post-operative immunotherapy. No significant improvement was observed for stage IIIA.

Sep 22, 2026

Upload by Lucas Martin