Determinants of survival in patients with brain metastases from cutaneous melanoma

Abstract

BACKGROUND: This retrospective study aimed to identify prognostic factors in patients with brain metastases from cutaneous melanoma. METHODS: In all, 265 patients under regular screening according to valid national surveillance guidelines were included in the study. Kaplan -Meier analyses were performed to estimate and to compare overall survival. Cox modeling was used to identify independent determinants of the overall survival, which were used in explorative classification and regression tree analysis to define meaningful prognostic groups. RESULTS: In total, 55.5% of our patients presented with two or less brain metastases, 82.6% had concurrent extracranial metastasis and 64% were asymptomatic and diagnosed during surveillance scans. In all, 36.7% were candidates for local treatment (neurosurgery or stereotactic radiosurgery (SRS)). The median overall survival of the entire collective was 5.0 months (95% confidence interval: 4.3 -5.7). Favourable independent prognostic factors were: normal pre-treatment level of serum lactate dehydrogenase (Po0.001), administered therapy (neurosurgery or SRS vs other, P ¼ 0.002), number of brain metastases (single vs multiple, P ¼ 0.032) and presence of bone metastasis (false vs true, P ¼ 0.044). Three prognostic groups with significantly different overall survival were identified. Candidates for local treatment (group I) had the longer median survival (9 months). Remaining patients could be further classified in two groups on the basis of serum lactate dehydrogenase. CONCLUSION: Applied treatment and serum lactate dehydrogenase levels were independent predictors of survival of patients with brain metastases from cutaneous melanoma. Patients receiving local therapy have overall survival comparable with general stage IV melanoma patients.

The effectiveness of brain metastases radiotherapy in patients with melanoma

“…Table VI presents the values of average survival periods of patients with MBM depending on the KPS score, which were 5.9-6.3 months for KPS ≥ 70 and were definitely lower in patients with a poorer general performance (KPS < 70), where they varied from 1.8 to 3.8 months. The results based on the site's material are comparable with those presented with other authors [5,13,14,37,40,46]. The other, generally accepted prognostic factor is the number of MBM foci.…”

“…Staudt et al claim that relatively good prognoses can only be made in patients with a single metastatic focus [40]. Rades et al in turn, distinguishes two groups of patients: with 1-3 MBM foci and with more than 3 MBM foci; and Weltman and Sperduto propose breaking down the patient groups into 3 categories: with 1, with 2-3 and more than 3 MBM [32,34,36].…”

“…The other, generally accepted prognostic factor is the number of MBM foci. The best prognoses concerned the patients with a single metastatic focus [17,32,35,36,40]; the increase of the MBM number is associated with a deterioration of the patient's prognosis [17,32,35,36].…”

Systematic Analysis of Whole Exome Sequencing Determines RET G691S Polymorphism as Germline Variant in Melanoma

“…2 A recent large study of almost 700 patients diagnosed with melanoma brain metastases found a mean survival time of less than 5 months. 3 Melanoma metastasizing to the central nervous system is not unexpected considering that during development neural crest cells are the precursor cells for melanocytes, where melanoma originates. 4 Additionally, one of the common findings in melanoma is neuronal tracking, and it has been suggested that this may be related to expression of the proto-oncogene RET.…”

Editorial: Stage IV melanoma

“…Importantly, some key modifiers of survival were not reported, including pretreatment levels of lactate dehydrogenase, hemorrhage within the metastatic tumor bed, recursive partitioning analysis class, and status of systemic disease at treatment onset. 2,5,7 One last important unknown is any deEditorial finitive inclusion and exclusion criteria qualifying a patient for ipilimumab therapy. Notwithstanding these limitations, all inherent to a retrospective review, the impressive survival differences argue for aggressive prospective evaluation of ipilimumab in patients with Stage IV melanoma with cerebral metastases.…”