Predictors and survival in patients with melanoma brain metastases

Abstract

Brain metastases (BM) are one of the most frequent neurological complications of cancers. Melanoma is the third most common tumor to metastasize to the brain with a reported incidence of 10-40 %, and many patients have subclinical BM (>73 %). We computer-searched the clinical records of all our patients registered into a database to identify patients that presented or developed BM. A total of 49 patients with melanoma BM were included in our analysis. General time to brain metastases (TTBM) was 23 months. The nonparametric test between TTBM and the single variables showed an association between TTBM and Breslow thickness (p < 0.0076; Spearman's coefficient-0.411), ulceration (p = 0.0656; Spearman's coefficient-0.287) and positive sentinel lymph node (p < 0.0015; Spearman's coefficient-0.475). Performing multiple regression, positive SLN remained the only, statistically significant, predictive variable (p < 0.01). Regarding the first melanoma site, the axial sites were more likely to develop BM than peripheral ones (p < 0.001). The analysis of brain metastasis survival (BMS) with Kaplan-Meier curves has resulted in a median survival rate of 6 months (range 1-134 months) and was strongly related to response to treatment, number of parenchymal lesions, presence or absence of symptoms. The results of the current analysis revealed clinical and primary tumor characteristics associated with the development of BM, TTBM, and BMS. The SNL was found to be the strongest predictor for BM development.