Predictive factors for the development of brain metastases in patients with malignant melanoma: a study by the Anatolian society of medical oncology

Gümüşay, Özge; Coşkun, Uğur; Akman, Tülay; Ekinci, Ahmet; Kocar, Muharrem; Erceleb, Özlem Balvan; Yazıcı, Ozan; Kaplan, Mehmet Ali; Berk, Velı; Çetin, Bülent; Taşköylü, Burcu Yapar; Yıldız, Ayhan; Alacacıoğlu, Ahmet; Demirci, Umut; Algın, Efnan; Uysal, Mükremın; Öztop, İlhan; Öksüzoğlu, Berna; Dane, Faysal; Gümüş, Mahmut; Büyükberber, Süleyman

doi:10.1007/s00432-013-1553-7

Cited by 15 publications

(21 citation statements)

References 22 publications

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“…Our study confirms the correlation of BM development with advanced tumor stage, particularly including Breslow depth >4 mm [5,6,8,11,19] as reported by others. We did not find that ulceration was associated with BM, as seen in two prior studies [10,17], although multiple other studies [5,6,8,9,11] reported a correlation.…”

Section: Discussionsupporting

confidence: 92%

“…We did not find that ulceration was associated with BM, as seen in two prior studies [10,17], although multiple other studies [5,6,8,9,11] reported a correlation. Curiously, Frankel et al [10] found that thinner primary tumors were associated with BM, although we observed a lower frequency of BM in patients with tumors <1 mm in depth.…”

Section: Discussioncontrasting

confidence: 62%

“…Prior retrospective studies of melanoma patients with BM examined cohorts ranging in size from 49 to 670 patients [5,6,8-12]. The rate of BM in these cohorts was approximately 10% [5,6,8,9,11,13], which corresponds to the expected risk of developing BM after a diagnosis of primary cutaneous melanoma [2].…”

Section: Discussionmentioning

confidence: 99%

“…The rate of BM in these cohorts was approximately 10% [5,6,8,9,11,13], which corresponds to the expected risk of developing BM after a diagnosis of primary cutaneous melanoma [2]. Our cohort of 123 melanoma patients with BM represented just over 2% of patients in our melanoma database; this lower percentage likely reflects the composition of our database, which contains many patients with melanoma in situ.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, our findings are consistent with a recent report by Gorka et al [11] showing that risk of BM correlated with proximity of the primary tumor to the brain. Multiple studies [6,8,9,11,13,18,19], but not all [10,17], have shown that primary tumors of the head and neck were more likely to develop BM. In our cohort, patients with primary tumor of the scalp accounted for most of the difference in clinical outcome between those with head and neck tumors and other sites, as those with head and neck tumors excluding scalp behaved similarly to those with tumors on an extremity.…”

Section: Discussionmentioning

confidence: 99%

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Risk factors for development of melanoma brain metastasis and disease progression: a single-center retrospective analysis

Gardner¹,

Ward

Andtbacka

et al. 2017

Melanoma Research

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Objective Melanoma metastasis to the brain is associated with poor prognosis. We sought to determine patient demographics and primary tumor factors associated with development of brain metastasis (BM) and survival. We also investigated whether the BM detection setting (routine screening vs. symptomatic presentation) affected clinical outcomes. Methods A database of melanoma patients seen from 1999-2015 at our institution was reviewed to identify patients that developed BM. Patients with BM were matched by initial stage with patients who did not develop BM as a control group. Patient demographics, primary tumor characteristics, and clinical outcomes were analyzed. Results 123 patients with BM were matched by initial presenting stage to 237 patients without BM. Characteristics of the primary melanoma tumor associated with BM development included location on the scalp (P=0.030), nodular histologic type (P=0.020) and Breslow depth >4mm (P=0.048), while location on the leg was associated with decreased BM risk (P=0.006). In patients with BM, time to first recurrence for melanomas of the scalp was significantly shorter (10.8 vs. 24.8 months, p=0.007) than non-scalp head and neck tumors. Patient stage, tumor depth, nodular type, and ulceration were also associated with worse clinical outcomes. There were no differences in clinical outcomes between patients whose BM were detected upon routine screening vs. upon symptomatic presentation. Conclusions Factors predictive of developing BM included primary scalp location, nodular type, and depth. In BM patients, scalp location, stage, tumor depth, nodular type and ulceration, but not detection setting, were associated with worse clinical outcomes.

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Section: Discussionsupporting

confidence: 92%

Section: Discussioncontrasting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Risk factors for development of melanoma brain metastasis and disease progression: a single-center retrospective analysis

Gardner¹,

Ward

Andtbacka

et al. 2017

Melanoma Research

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High frequency of brain metastases after adjuvant therapy for high‐risk melanoma

et al. 2017

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The incidence of CNS progression in patients with high‐risk regional melanoma (stages IIIAN2a‐IIIC) is not well characterized. Data from the S0008 trial provided an opportunity to examine the role of CNS progression in treatment failure and survival. All patients were surgically staged. Following wide excision and full regional lymphadenectomy, patients were randomized to receive adjuvant biochemotherapy (BCT) or high‐dose interferon alfa‐2B (HDI). CNS progression was retrospectively identified from data forms. Survival was measured from date of CNS progression. A total of 402 eligible patients were included in the analysis (BCT: 199, HDI: 203). Median follow‐up (if alive) was over 7 years (range: 1 month to 11 years). The site of initial progression was identifiable in 80% of relapsing patients. CNS progression was a component of systemic melanoma relapse in 59/402 patients (15% overall). In 34/402 patients (9%) CNS progression represented the initial site of treatment failure. CNS progression was a component of initial progression in 27% of all patients whose melanoma relapsed (59/221). The risk of CNS progression was highest within 3 years of randomization. The difference in CNS progression rates between treatment arms was not significant (BCT = 25, HDI = 34, P = 0.24). Lymph node macrometastases strongly associated with CNS progression (P = 0.001), while ulceration and head and neck primaries were not significant predictors. This retrospective analysis of the S0008 trial identified a high brain metastasis rate (15%) in regionally advanced melanoma patients. Further studies are needed to establish whether screening plus earlier treatment would improve survival following CNS progression.

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Predictive value of a nomogram for melanomas with brain metastases at initial diagnosis

Guo

et al. 2019

Cancer Medicine

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Background Estimation of incidence and prognosis of melanomas with brain metastases (MBM) at initial diagnosis based on a large cohort is lacking in current research. This study aims to construct an effective prognostic nomogram for newly diagnosed MBM. Materials and Methods Patients diagnosed with melanomas from Surveillance, Epidemiology, and End Results program between 2010 and 2014 were enrolled in our study. Risk factors predicting brain metastases (BM) were identified using logistic regression analysis. Cox regression analysis was performed to identify prognostic factors of overall survival (OS). Nomogram for estimating 6‐, 9‐, and 12‐month OS was established based on Cox regression analysis. The discriminative ability and calibration of the nomogram were tested using C statistics, calibration plots, and Kaplan‐Meier curves. Results Sixty‐two thousand three hundred and sixty‐nine melanoma patients were enrolled, including 928 with BM. Sex, marital status, insurance status, subsite, surgery of primary sites, radiation, chemotherapy, bone metastases, liver metastases, and lung metastases were associated with MBM at initial diagnosis. On multivariable Cox regression, the following eight variables were incorporated in the prediction of OS: age, unmarried status, absence of surgery to primary sites or unknown, absence of radiation or unknown, absence of chemotherapy or unknown, with bone metastases, with liver metastases, and with lung metastases. The nomogram showed good predictive ability as indicated by discriminative ability and calibration, with the C statistics of 0.716 (95% CI, 0.695‐0.737). Conclusions The incidence and prognosis of MBM patients were well estimated in this study based on a large cohort. The nomogram performed well and could be a useful tool to predict prognosis.

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Predictive factors for the development of brain metastases in patients with malignant melanoma: a study by the Anatolian society of medical oncology

Abstract: Our results revealed the importance of primary tumor characteristics associated with the development of BMs. Ulceration, primary tumor thickness, anatomic site, and pathologic ≥N2 disease were found to be significant predictors of BMs development.

Cited by 15 publications

References 22 publications

Risk factors for development of melanoma brain metastasis and disease progression: a single-center retrospective analysis

Risk factors for development of melanoma brain metastasis and disease progression: a single-center retrospective analysis

High frequency of brain metastases after adjuvant therapy for high‐risk melanoma

Predictive value of a nomogram for melanomas with brain metastases at initial diagnosis

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