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Brain and leptomeningeal metastases from cutaneous melanoma: Survival outcomes based on clinical features

Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA (J.J.R.); Department of Melanoma Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA (W.-J.H., G.A.); Department of Medicine, New York University School of Medicine, New York, NY, USA (D.E.B.); Department of Biostatistics (K.S.P., A.W.), Department of Internal Medicine, Immunology Section (E.B., C.A., L.A.L.), and Section of Neurosurgery, Department of Surgery (M.H.B., P.H.G.), Memorial Sloan-Kettering Cancer Center, New York, NY, USA

Address correspondence to Jeffrey J. Raizer, MD, Northwestern University, Feinberg School of Medicine, Department of Neurology, 710 North Lake Shore Drive, Abbott Hall Room 1123, Chicago, IL 60611, USA (jraizer{at}nmff.org).

Brain metastases (BM) are among the most devastating and debilitating complications of melanoma. This retrospective study was conducted to gain a better understanding of patient and disease characteristics that have the greatest impact on overall survival in melanoma patients with BM; therapeutic interventions were also assessed. The records of all patients diagnosed with cutaneous melanoma and BM who were seen at Memorial Sloan-Kettering Cancer Center between 1991 and 2001 were retrospectively reviewed. A variety of factors, including age at diagnosis of stage IV disease, gender, race, disease stage at diagnosis, presence of BM at diagnosis of stage IV disease, neurologic symptoms, radiographic findings, number of BM, status and site(s) of extracranial metastasis, and treatment modalities, were analyzed for correlation with overall survival using univariate and multivariate Cox regression models. The records of 355 patients with BM were included in the analysis. On univariate analysis, seven patient and disease characteristics were significantly associated with poorer survival: age > 65 years, extracranial metastases, BM at stage IV diagnosis, neurologic symptoms, four or more BM, hydrocephalus, and leptomeningeal metastases. Of these, age, extracranial metastasis, neurologic symptoms, and number of BM were significantly associated with poorer survival in a multivariate analysis. Multivariate analysis of treatment modalities suggested that patients who had surgery, radiosurgery, or chemotherapy with temozolomide had improved survival outcomes, although this analysis has limitations. The prognostic factors identified in this retrospective study should be considered when making treatment decisions for patients with BM and used as stratification factors in future clinical trials.

Key Words: brain metastases • Cox regression model • melanoma • prognosis • survival

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