Demographics, prognosis, and therapy in 702 patients with brain metastases from malignant melanoma
Demographics, prognosis, and therapy in 702 patients with brain metastases from malignant melanoma
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DOI：
10.3171/jns.1998.88.1.0011
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发表时间：
1998-01-01
影响因子：
4.1
通讯作者：
Seigler, HF
中科院分区：
文献类型：
--
作者：
Sampson, JH;Carter, JH;Seigler, HF
脑转移是恶性黑色素瘤患者常见且毁灭性的并发症。这些患者的治疗选择有限，预后通常较差。回顾性分析了6953例在同一医院接受治疗的黑色素瘤患者，以确定702例患者中与临床显著脑转移发展相关的人口统计学因素，并确定影响该人群预后的因素，从而为手术治疗提供更明智的建议。与脑转移发展相关的因素包括男性、位于粘膜表面或躯干或头颈部皮肤的原发病变、原发病变变厚或溃疡，以及肢端黄斑状或结节状病变的组织学表现。所有脑转移患者的总体中位生存时间为113.2天，这些转移导致该组94.5%的患者死亡。与其他脑转移患者相比，原发病灶位于头部或颈部的患者生存时间明显较短，而单发脑转移患者、无肺或多发性其他内脏转移患者以及最初出现脑转移的黑色素瘤患者预后明显较好。存活超过3年的一小部分患者的特点是在没有其他内脏转移性疾病的情况下存在手术治疗的单脑转移。虽然大多数由黑色素瘤引起的脑转移患者预后不佳，但一些可能存活较长时间的患者可以被识别出来。在这些患者中，手术切除可以显著延长有意义的生存期。建议手术的决定应主要基于脑转移的可切除性以及其他器官转移病变的状态和数量。
Brain metastases are a common and devastating complication in patients with malignant melanoma. Therapeutic options for these patients are limited, and the prognosis is usually poor.Object. A retrospective review of 6953 patients with melanoma treated at a single institution was undertaken to identify demographic factors associated with the development of clinically significant brain metastases in 702 of these patients and to determine the factors influencing the prognosis of this population to permit more informed recommendations regarding surgical therapy.Methods. Factors found to be associated with the development of brain metastases included male gender, primary lesions located on mucosal surfaces or on the skin of the trunk or head and neck, thick or ulcerated primary lesions, and histological findings of acral lentiginous or nodular lesions. The overall median survival time of all patients with brain metastases was 113.2 days, and these metastases contributed to the death of 94.5% of the patients in this group. Patients with primary lesions located in the head or neck region had a significantly shorter survival time relative to other patients with brain metastases, whereas patients with a single brain metastasis, patients without lung or multiple other visceral metastases, and patients whose initial presentation with melanoma included a brain metastasis had a significantly better prognosis. The small group of patients who survived for more than 3 years was characterized by the presence of a surgically treated, single brain metastasis in the absence of other visceral metastatic disease.Conclusions. Although most patients with brain metastases resulting from melanoma have a dismal prognosis, some who are likely to survive for longer periods can be identified. In these patients surgical resection can significantly prolong meaningful survival. The decision to recommend surgery should be based primarily on the resectability of the brain metastases and on the status and number of other organs with metastatic lesions.