Saberian Chantal, Milton Denái R, Simon Julie, Amaria Rodabe N, Diab Adi, McQuade Jennifer, Patel Sapna P, Tawbi Hussein, Yee Cassian, Wong Michael K, McCutcheon Ian E, Davies Michael A, Ferguson Sherise D, Glitza Oliva Isabella C
Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Neurooncol Pract. 2024 Mar 30;11(4):452-463. doi: 10.1093/nop/npae026. eCollection 2024 Aug.
Melanoma leptomeningeal disease (LMD) has a poor prognosis. However, the management of patients with advanced melanoma has evolved with time, including those with LMD. We reviewed a large cohort of melanoma LMD patients to assess factors associated with survival.
Retrospective clinical data was collected on patients diagnosed with LMD at MD Anderson Cancer Center from 2015 to 2020. Overall survival (OS) was determined from LMD diagnosis to date of death or last follow-up. The Kaplan-Meier method and log-rank test were used to estimate OS and to assess univariate group differences, respectively. Multivariable associations of survival with variables of interest were determined using Cox proportional hazards regression models.
A total of 172 patients were identified. The median age at LMD diagnosis was 53 (range 20-79) years, and all patients had radiographic evidence of LMD on magnetic resonance imaging of either brain or spine. In total 143 patients previously received systemic therapy (83%), with a median of 2 prior treatments (range 0-5). 81 patients (47%) had concurrent uncontrolled systemic disease and 80 patients (53%) had elevated serum LDH at the time of diagnosis. With a median follow-up of 4.0 months (range 0.1-65.3 months), median OS for all patients from LMD diagnosis was 4.9 months. Patients ( = 45) who received intrathecal therapy or systemic immunotherapy for LMD had a median OS of 8.0 months and 10.2 months, respectively. On multivariable analysis, decreased performance status, positive CSF cytology, elevated LDH, and whole brain radiation were associated with worse OS.
Despite many advances in therapeutic options, the outcomes of melanoma patients with LMD remains poor. However, a subset of patients appears to derive benefit from LMD-directed treatment.
黑色素瘤软脑膜疾病（LMD）预后较差。然而，晚期黑色素瘤患者的治疗方法随着时间不断发展，包括患有LMD的患者。我们回顾了一大群黑色素瘤LMD患者，以评估与生存相关的因素。
收集了2015年至2020年在MD安德森癌症中心被诊断为LMD的患者的回顾性临床数据。总生存期（OS）从LMD诊断之日起至死亡或最后一次随访之日确定。分别使用Kaplan-Meier方法和对数秩检验来估计OS并评估单变量组间差异。使用Cox比例风险回归模型确定生存与感兴趣变量的多变量关联。
共识别出172例患者。LMD诊断时的中位年龄为53岁（范围20 - 79岁），所有患者在脑部或脊柱的磁共振成像上均有LMD的影像学证据。总共有143例患者先前接受过全身治疗（83%），先前治疗的中位数为2次（范围0 - 5次）。81例患者（47%）在诊断时同时患有未控制的全身疾病，80例患者（53%）血清乳酸脱氢酶（LDH）升高。中位随访时间为4.0个月（范围0.1 - 65.3个月），所有患者从LMD诊断起的中位OS为4.9个月。因LMD接受鞘内治疗或全身免疫治疗的患者（n = 45）的中位OS分别为8.0个月和10.2个月。多变量分析显示，体能状态下降、脑脊液细胞学阳性、LDH升高和全脑放疗与较差的OS相关。
尽管治疗选择有了许多进展，但黑色素瘤LMD患者的预后仍然很差。然而，一部分患者似乎从针对LMD的治疗中获益。
