Predictors and survival in patients with melanoma brain metastases

Abstract

Brain metastases (BM) are one of the most frequent neurological complications of cancers. Melanoma is the third most common tumor to metastasize to the brain with a reported incidence of 10-40 %, and many patients have subclinical BM (>73 %). We computer-searched the clinical records of all our patients registered into a database to identify patients that presented or developed BM. A total of 49 patients with melanoma BM were included in our analysis. General time to brain metastases (TTBM) was 23 months. The nonparametric test between TTBM and the single variables showed an association between TTBM and Breslow thickness (p < 0.0076; Spearman's coefficient-0.411), ulceration (p = 0.0656; Spearman's coefficient-0.287) and positive sentinel lymph node (p < 0.0015; Spearman's coefficient-0.475). Performing multiple regression, positive SLN remained the only, statistically significant, predictive variable (p < 0.01). Regarding the first melanoma site, the axial sites were more likely to develop BM than peripheral ones (p < 0.001). The analysis of brain metastasis survival (BMS) with Kaplan-Meier curves has resulted in a median survival rate of 6 months (range 1-134 months) and was strongly related to response to treatment, number of parenchymal lesions, presence or absence of symptoms. The results of the current analysis revealed clinical and primary tumor characteristics associated with the development of BM, TTBM, and BMS. The SNL was found to be the strongest predictor for BM development.

Malignant melanoma brain metastases: Treatment results and prognostic factors - a single-center retrospective study

“…In the literature, extracranial metastatic involvement is reported in 65-83% (10,37,39,43,45) of patients and in 37-51% of cases, multiple organ systems are affected by extracerebral metastasis (10,37). In 22% of the patients in our study, lymph nodes were positive for metastasis upon initial diagnosis of melanoma and 61% of patients developed metastatic spread to lymphatic nodes during their disease course which stands in line with current literature, reporting lymph node metastasis in 24-54% (17,39).…”

“…Fife et al reported a median age at the time of diagnosis of brain metastasis of 49 and 57 years with a median time from initial diagnosis of melanoma until occurrence of cerebral metastasis of 2.5 and 3.7 years (10). In our study, patients were older when brain metastasis was confirmed (62 years), however, median time to development of cerebral metastasis (2.5 years in our patient group) was comparable with current literature (1.9-2.7 years) (17,18,37,39).…”

“…Male gender in our study was more frequent than female gender (65 vs. 35%) which is similar to the gender distribution in other reports (10,17,37,39,43). Unlike the study of hofmann et al, we did not find a significant influence of gender on survival (44).…”

“…Median survival in our study was 3.9 months which is shorter compared to other relevant studies in this field (10,17,18,37,39,41). Moreover, the majority of our patients displayed extracranial metastasis and was diagnosed with nodular type melanoma which was associated with a considerably poor prognosis.…”

“…Few studies elucidated potential risk factors for the development of brain metastases in malignant melanoma including gender, Breslow thickness, ulceration, melanoma location, histological type, certain genetic alterations (i.e., BRAF mutation) and positive sentinel node (7,(17)(18)(19).…”