文章：

黑色素瘤中枢神经系统转移的预测与预后因素——一项队列研究

Predictive and Prognostic Factors in Melanoma Central Nervous System Metastases—A Cohort Study

原文发布日期：19 June 2024

DOI: 10.3390/cancers16122272

类型: Article

开放获取: 是

英文摘要：

Background: Melanoma is the cancer with the highest risk of dissemination to the central nervous system (CNS), one of the leading causes of mortality from this cancer. Objective: To identify patients at higher risk of developing CNS metastases and to evaluate associated prognostic factors. Methods: A cohort study (1998–2023) assessed patients who developed CNS melanoma metastases. Multivariate logistic regression was used to identify predictive factors at melanoma diagnosis for CNS metastasis. Cox regression analysis evaluated the CNS-independent metastasis-related variables impacting survival. Results: Out of 4718 patients, 380 (8.05%) developed CNS metastases. Multivariate logistic regression showed that a higher Breslow index, mitotic rate ≥ 1 mm2, ulceration, and microscopic satellitosis were significant risk factors for CNS metastasis development. Higher patient age and the location of the primary tumor in the upper or lower extremities were protective factors. In survival analysis, post-CNS metastasis, symptomatic disease, prior non-CNS metastases, CNS debut with multiple metastases, elevated LDH levels, and leptomeningeal involvement correlated with poorer survival. Conclusion: Predictive factors in the primary tumor independently associated with brain metastases include microscopic satellitosis, ulceration, higher Breslow index, and trunk location. Prognostic factors for lower survival in CNS disease include symptomatic disease, multiple CNS metastases, and previous metastases from different sites.

摘要翻译： 

背景：黑色素瘤是向中枢神经系统（CNS）播散风险最高的癌症，也是导致该癌症死亡的主要原因之一。目的：识别发生CNS转移风险较高的患者，并评估相关预后因素。方法：一项队列研究（1998–2023年）评估了发生CNS黑色素瘤转移的患者。采用多变量逻辑回归分析确定黑色素瘤诊断时对CNS转移的预测因素。Cox回归分析评估了影响生存的CNS非依赖性转移相关变量。结果：在4718例患者中，380例（8.05%）发生了CNS转移。多变量逻辑回归显示，较高的Breslow指数、有丝分裂率≥1 mm²、溃疡和显微镜下卫星灶是发生CNS转移的重要风险因素。较高的患者年龄和原发肿瘤位于上肢或下肢是保护因素。在生存分析中，CNS转移后出现症状性疾病、既往非CNS转移、CNS首发为多发性转移、LDH水平升高以及软脑膜受累与较差的生存率相关。结论：与原发肿瘤相关的独立预测脑转移的因素包括显微镜下卫星灶、溃疡、较高的Breslow指数和躯干位置。CNS疾病中生存率较低的预后因素包括症状性疾病、多发性CNS转移以及既往不同部位的转移。

原文链接：

Predictive and Prognostic Factors in Melanoma Central Nervous System Metastases—A Cohort Study