Risk and tropism of central nervous system (CNS) metastases in patients with stage II and III cutaneous melanoma.
Risk and tropism of central nervous system (CNS) metastases in patients with stage II and III cutaneous melanoma.
复制标题
II 期和 III 期皮肤黑色素瘤患者中枢神经系统 (CNS) 转移的风险和趋向性。
作者：
Johannet,Paul;Simons,Morgan;Qian,Yingzhi;Azmy,Nadine;Mehnert,JaniceM;Weber,JeffreyS;Zhong,Judy;Osman,Iman
背景最近的数据表明，III期黑色素瘤患者发生中枢神经系统(CNS)转移的风险很高。由于一组II期黑色素瘤患者的生存结果比某些III期黑色素瘤患者更差，作者调查了II期黑色素瘤患者中枢神经系统转移的风险，为这一人群的监测提供指导。方法作者检查了前瞻性收集的1054名皮肤黑色素瘤患者的临床病理数据。结果III期黑色素瘤患者脑转移率高于II期黑色素瘤患者(分别为21.4%和14.0%，P =0.002)。然而，IIC期黑色素瘤患者的中枢神经系统孤立首次复发率显著高于III期患者(12.1%对3.6%；p=2.002)。对于IIC期(危险比，3.16；95%CI，1.77-5.66)、IIIB期(HR，2.83；95%CI，1.63-4.91)和IIIC期(HR，2.93；95%CI，1.81-4.74)的患者，发生脑转移的风险也同样增加，并且IIID期患者的风险最高(HR，8.59；95%CI：4.11-17.97)。结论IIC期黑色素瘤患者在中枢神经系统首次复发的风险较高。在识别出更准确的预测标记物之前，应该考虑对这些个体采用结合了连续神经成像的监测策略。
BackgroundRecent data suggest that patients with stage III melanoma are at high risk for developing central nervous system (CNS) metastases. Because a subset of patients with stage II melanoma experiences worse survival outcomes than some patients with stage III disease, the authors investigated the risk of CNS metastasis in stage II melanoma to inform surveillance guidelines for this population.MethodsThe authors examined clinicopathologic data prospectively collected from 1054 patients who had cutaneous melanoma. The χ2test, the cumulative incidence, and Cox multivariable regression analyses were performed to evaluate the association between baseline characteristics and the development of CNS metastases.ResultsPatients with stage III melanoma had a higher rate of developing brain metastases than those with stage II melanoma (100 of 468 patients [21.4%] vs. 82 of 586 patients [14.0%], respectively;p =.002). However, patients who had stage IIC melanoma had a significantly higher rate of isolated first recurrences in the CNS compared with those who had stage III disease (12.1% vs. 3.6%;p= .002). The risk of ever developing brain metastases was similarly elevated for patients who had stage IIC disease (hazard ratio [HR], 3.16; 95% CI, 1.77–5.66), stage IIIB disease (HR, 2.83; 95% CI, 1.63–4.91), and stage IIIC disease (HR, 2.93; 95% CI, 1.81–4.74), and the risk was highest in patients who had stage IIID disease (HR, 8.59; 95% CI: 4.11–17.97).ConclusionsPatients with stage IIC melanoma are at elevated risk for first recurrence in the CNS. Surveillance strategies that incorporate serial neuroimaging should be considered for these individuals until more accurate predictive markers can be identified.