Survival Nomogram for Stage IV (M1a-c) Melanoma: A Population-Based Study Highlighting the Prognostic Correlates of Surgery in Pre-Immunotherapy and Early Immunotherapy Eras.

Authors

Dun-Chang Mo, Jian-Feng Huang, Peng-Hui Luo, Peng Lin, Shang-Xiao Huang, Han-Lei Wang, Xiu-Juan Liang

Published in

Journal of investigative surgery : the official journal of the Academy of Surgical Research. Volume 39. Issue 1. Pages 2702186. Epub Jul 14, 2026.

Abstract

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.
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.
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 < 0.001). The benefit was pronounced in the M1a (40.5 vs. 20.0 months, p < 0.001) and M1c (11 vs. 5 months, p < 0.001) subgroups. Patients in the early immunotherapy era had longer OS (8 vs. 6 months, p < 0.001).
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.

PMID:
42446161
Bibliographic data and abstract were imported from PubMed on 14 Jul 2026.

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