The New York University Interdisciplinary Melanoma Cooperative Group, New York University School of Medicine and New York University Cancer Institute, New York, New York, USA.
Cancer. 2011 Apr 15;117(8):1711-20. doi: 10.1002/cncr.25643. Epub 2010 Nov 8.
Melanoma patients who develop brain metastases (B-Met) have limited survival and are excluded from most clinical trials. In the current study, the authors attempted to identify primary tumor characteristics and clinical features predictive of B-Met development and post-B-Met survival.
A prospectively accrued cohort of 900 melanoma patients was studied to identify clinicopathologic features of primary melanoma (eg, thickness, ulceration, mitotic index, and lymphovascular invasion) that are predictive of B-Met development and survival after a diagnosis of B-Met. Associations between clinical variables present at the time of B-Met diagnosis (eg, extracranial metastases, B-Met location, and the presence of neurological symptoms) and post-B-Met survival were also assessed. Univariate associations were analyzed using Kaplan-Meier survival analysis, and the effect of independent predictors was assessed using multivariate Cox proportional hazards regression analysis.
Of the 900 melanoma patients studied, 89 (10%) developed B-Met. Ulceration and site of the primary tumor on the head and neck were found to be independent predictors of B-Met development on multivariate analysis (P = .001 and P = .003, respectively). Clinical variables found to be predictive of post-B-Met survival on multivariate analysis included the presence of neurological symptoms (P = .008) and extracranial metastases (P = .04). Ulceration was the only primary tumor characteristic that remained a significant predictor of post-B-Met survival on multivariate analysis (P = .04).
Primary tumor ulceration was found to be the strongest predictor of B-Met development and remained an independent predictor of decreased post-B-Met survival in a multivariate analysis inclusive of primary tumor characteristics and clinical variables. The results of the current study suggest that patients with ulcerated primary tumors should be prospectively studied to determine whether heightened surveillance for B-Met can improve clinical outcome.
发生脑转移（B-Met）的黑色素瘤患者的生存时间有限，且被排除在大多数临床试验之外。在本研究中，作者试图确定可预测 B-Met 发展和 B-Met 后生存的原发肿瘤特征和临床特征。
对 900 例黑色素瘤患者进行前瞻性队列研究，以确定原发黑色素瘤的临床病理特征（如厚度、溃疡、有丝分裂指数和血管淋巴管侵犯），这些特征可预测 B-Met 的发展和 B-Met 诊断后的生存情况。还评估了 B-Met 诊断时存在的临床变量（如颅外转移、B-Met 位置和神经系统症状的存在）与 B-Met 后生存之间的关系。使用 Kaplan-Meier 生存分析对单变量相关性进行分析，并使用多变量 Cox 比例风险回归分析评估独立预测因子的作用。
在所研究的 900 例黑色素瘤患者中，89 例（10%）发生了 B-Met。多变量分析发现溃疡和头颈部原发肿瘤部位是 B-Met 发展的独立预测因素（P=0.001 和 P=0.003）。多变量分析发现对 B-Met 后生存有预测作用的临床变量包括存在神经系统症状（P=0.008）和颅外转移（P=0.04）。溃疡是唯一在多变量分析中仍为 B-Met 后生存的显著预测因素（P=0.04）。
原发肿瘤溃疡被发现是 B-Met 发展的最强预测因素，并且在包括原发肿瘤特征和临床变量的多变量分析中仍然是 B-Met 后生存的独立预测因素。本研究结果表明，应前瞻性研究溃疡性原发肿瘤患者，以确定是否加强对 B-Met 的监测可以改善临床结局。
