Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY 10016, USA.
Neuro Oncol. 2012 Jul;14(7):849-58. doi: 10.1093/neuonc/nos113. Epub 2012 May 3.
Melanoma brain metastasis that develops as the isolated first visceral site challenges the current paradigm of tumor progression in which brain metastasis is regarded as the final stage. Here we test the hypothesis that melanoma patients who develop brain metastasis as the isolated first visceral site have distinct clinicopathological features at the time of primary melanoma diagnosis. Cutaneous melanoma patients enrolled in 2 prospectively collected databases were studied (Cohort 1: 1972-1982, Cohort 2: 2002-2009). Patients who developed brain metastasis as isolated first visceral site were compared with (1) all other patients, (2) patients who developed visceral metastasis: extracranial only or extracranial and brain, and (3) patients who progressed to other isolated visceral sites first. Two hundred seven of 2280 (9.1%) patients developed brain metastasis (median follow-up, 5.2 y). Seventy-four of 207 (35.7%) brain metastasis patients progressed to brain metastasis as the isolated first visceral site. These patients presented with primaries that were thinner and had no mitosis compared with all other visceral metastasis patients (Fisher's combined P = .02, .05, respectively), and there was a significant difference in American Joint Committee on Cancer stage distribution at initial melanoma diagnosis (combined P = .02). Post-visceral metastasis survival, however, was shorter in patients with brain metastasis as isolated first visceral site than in patients with visceral metastasis: extracranial and brain (combined P = .03). Brain metastasis as isolated first visceral site is a distinct clinicopathological entity. Studies are needed to better understand the biological factors driving this phenotype at the time of primary melanoma diagnosis and to determine its clinical implications.
黑色素瘤脑转移作为孤立的首个内脏转移部位出现，这对目前认为脑转移是疾病终末期的肿瘤进展模式提出了挑战。在这里，我们通过检测假设，即黑色素瘤患者在出现孤立的首个内脏转移部位时，在原发性黑色素瘤诊断时就具有独特的临床病理特征。对两个前瞻性收集的数据库中的黑色素瘤患者进行了研究（队列 1：1972-1982 年，队列 2：2002-2009 年）。将出现孤立的首个脑转移部位的患者与（1）所有其他患者，（2）出现内脏转移（仅颅外或颅外和脑内）的患者，以及（3）首先进展至其他孤立的内脏部位的患者进行了比较。在 2280 例患者中，有 207 例（9.1%）出现脑转移（中位随访时间为 5.2 年）。其中，74 例（35.7%）脑转移患者进展为孤立的首个脑转移部位。与所有其他内脏转移患者相比，这些患者的原发肿瘤更薄且无有丝分裂（Fisher 联合 P =.02，.05），且在初始黑色素瘤诊断时美国癌症联合委员会（AJCC）分期分布存在显著差异（联合 P =.02）。然而，与有脑外和脑内转移的患者相比，出现孤立的首个脑转移部位的患者在发生内脏转移后的生存时间更短（联合 P =.03）。孤立的首个脑转移部位是一个独特的临床病理实体。需要开展更多的研究来更好地了解在原发性黑色素瘤诊断时驱动这种表型的生物学因素，并确定其临床意义。
