Department of Radiation Oncology, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, QLD, 4102, Australia,
Clin Exp Metastasis. 2014 Jan;31(1):81-5. doi: 10.1007/s10585-013-9611-8. Epub 2013 Aug 23.
Brain metastases (BMs) are a major source of mortality and morbidity in patients with melanoma. This study assesses prognostic nodal factors in patients with nodal metastatic melanoma with respect to the development of BMs. The aim was to identify a high risk subset that may benefit from brain directed management. Prospective surgical and clinical trial databases identified patients who had had nodal dissections and were seen through the Princess Alexandra Hospital Melanoma clinic between August 1995 and June 2010. Patient data was collected and event data was updated from medical imaging and clinical records. The primary endpoint was the rate of development of BMs. 474 patients were identified as having nodal dissections. Two hundred and eighty-seven patients (61%) were male with a median age of 52 (39-66). The most common nodal dissection site was axilla 190 (40%), followed by groin 154 (32.5%) and neck 130 (27.5%). Adjuvant radiotherapy to the nodal basin was delivered to 134 patients (28%). BMs occurred in 61 patients (12.9%) with a median time of 13.87 months from dissection. No lymph node characteristics were significantly associated with the development of BMs including: nodal region (p=0.72), nodal size (p=0.08), number of involved nodes (p=0.36), presence of extra-capsular spread (p=0.47) and AJCC N stage. There was no significant association between primary ulceration (p=0.37) or location and development of BMs. It appears that for patients with resected stage III melanoma there is no histopathological lymph node feature associated with the development of BMs. This highlights the importance of identifying molecular markers in nodal melanoma which may predict for BMs to further direct site-specific therapy.
脑转移（BMs）是黑色素瘤患者死亡和发病的主要原因。本研究评估了具有淋巴结转移性黑色素瘤患者的淋巴结预后因素与 BMs 发展的关系。目的是确定可能受益于脑定向治疗的高危亚组。通过 Princess Alexandra 医院黑色素瘤诊所的前瞻性手术和临床试验数据库，确定了 1995 年 8 月至 2010 年 6 月期间接受过淋巴结清扫术的患者。收集患者数据，并通过医学影像和临床记录更新事件数据。主要终点是 BMs 的发展率。共确定 474 例患者进行了淋巴结清扫术。287 例（61%）患者为男性，中位年龄为 52 岁（39-66 岁）。最常见的淋巴结清扫部位是腋窝 190 例（40%），其次是腹股沟 154 例（32.5%）和颈部 130 例（27.5%）。134 例（28%）患者接受了淋巴结区域辅助放疗。61 例（12.9%）患者发生 BMs，从清扫到 BMs 的中位时间为 13.87 个月。没有淋巴结特征与 BMs 的发生显著相关，包括：淋巴结区域（p=0.72）、淋巴结大小（p=0.08）、受累淋巴结数量（p=0.36）、有无包膜外扩散（p=0.47）和 AJCC N 分期。原发溃疡（p=0.37）或位置与 BMs 的发生之间无显著相关性。对于接受过 III 期黑色素瘤切除术的患者，似乎没有与 BMs 发展相关的淋巴结组织学特征。这突显了在淋巴结黑色素瘤中识别可能预测 BMs 的分子标志物的重要性，以进一步指导针对特定部位的治疗。
