Miller Dorothea, Zappala Valeria, El Hindy Nicolai, Livingstone Elisabeth, Schadendorf Dirk, Sure Ulrich, Sandalcioglu Ibrahim Erol
Department of Neurosurgery, University Hospital Essen, Essen, Germany.
Clin Neurol Neurosurg. 2013 Sep;115(9):1721-8. doi: 10.1016/j.clineuro.2013.03.019. Epub 2013 May 1.
Brain metastases (BM) commonly occur in patients with metastatic malignant melanoma (MM). Prognosis is poor even with maximal therapy. The aim of the current study was to retrospectively evaluate patients with BM of MM who were treated neurosurgically with respect to clinical presentation, recurrent disease, survival and factors affecting survival.
Thirty-four patients (19f/15m) with BM of MM were treated in our hospital between 2000 and 2010. Patient data were analysed, survival was examined using Kaplan-Meier-estimates and factors affecting prognosis were evaluated using uni- and multivariate analysis.
Twenty-two patients (64.7%) had a single BM, whereas twelve patients (35.3%) revealed two or more lesions. Median survival for patients with a single BM was 13.0 months (95%-CI 9.3-16.7 months), this was significantly (p=0.014) better than for patients with two or more BM (median 5.0, 95%-CI 3.4-14.6 months). Nineteen patients (55.9%) developed an intracranial relapse after microsurgical resection of a first lesion. Patients with an isolated intracerebral relapse survived significantly (p=0.003) longer than those with systemic progression (median 6.0, 95%-CI 0.0-15.3 months vs median 3.0, 95%-CI 1.7-4.3 months). Similarly, patients with a high performance status showed significantly (p=0.001) prolonged survival (median 7.0, 95%-CI 0.0-19.9 months vs median 1.0, 95%-CI 0.0-2.2 months). Eleven out of nineteen patients (57.9%) underwent either another microsurgical resection (n=6) or stereotactic radiosurgery (n=5). These patients remained on a high performance status even after aggressive therapy.
Even though the prognosis for patients with BM of MM is generally poor, patients with a single BM can benefit from microsurgical resection. However, there is a high risk of intracranial relapse. In selected patients with a good performance status and recurrent intracranial disease, recurrent local therapy can be justified and useful.
脑转移瘤（BM）常见于转移性恶性黑色素瘤（MM）患者。即使采用最大程度的治疗，预后也很差。本研究的目的是回顾性评估接受神经外科治疗的MM脑转移患者的临床表现、疾病复发、生存情况以及影响生存的因素。
2000年至2010年间，我院共治疗了34例MM脑转移患者（19例女性/15例男性）。分析患者数据，采用Kaplan-Meier估计法检查生存情况，并使用单因素和多因素分析评估影响预后的因素。
22例患者（64.7%）有单个脑转移瘤，而12例患者（35.3%）有两个或更多病灶。单个脑转移瘤患者的中位生存期为13.0个月（95%置信区间9.3 - 16.7个月），这显著优于有两个或更多脑转移瘤的患者（中位生存期5.0个月，95%置信区间3.4 - 14.6个月，p = 0.014）。19例患者（55.9%）在首次病灶显微手术后出现颅内复发。孤立性颅内复发患者的生存期显著长于全身进展患者（中位生存期6.0个月，95%置信区间0.0 - 15.3个月 vs 中位生存期3.0个月，95%置信区间1.7 - 4.3个月，p = 0.003）。同样，体能状态良好的患者生存期显著延长（中位生存期7.0个月，95%置信区间0.0 - 19.9个月 vs 中位生存期1.0个月，95%置信区间0.0 - 2.2个月，p = 0.001）。19例患者中有11例（57.9%）接受了再次显微手术（n = 6）或立体定向放射外科治疗（n = 5）。这些患者即使在积极治疗后仍保持良好的体能状态。
尽管MM脑转移患者的预后总体较差，但单个脑转移瘤患者可从显微手术切除中获益。然而，颅内复发风险很高。对于体能状态良好且颅内疾病复发的特定患者，复发性局部治疗是合理且有效的。
