Background: Brain metastases are observed in more than 40% of all patients with stage 4 melanoma. In recent years, more extensive use of stereotactic radiation (STRT) and the advent of immune checkpoint inhibitors have positively impacted outcomes in patients with metastatic melanoma.brain metastases. Here, we examined real world clinical outcomes of patients presenting with melanoma brain metastases (MBMs). Methods: This retrospective review evaluated MBMs patients treated at The Ottawa Hospital from April 2000 to July 2017. Clinical, radiologic, pathologic and treatment information were gathered from the electronic medical records. The primary outcome was overall survival. The proportional Cox regression model was employed for survival data, while the Fisher's exact and Mann-Whitney U tests analyzed the relationship between categorical and continuous data, respectively. Results: This retrospective study included 276 patients. Brain metastases were detected symptomatically in 191 patients (69.2%); the rates of detection by routine screening were 4.6% in the pre-2012 era and 11.7% in the contemporary era (p = 0.029). Median survival was three months. Predictors of overall survival were age, higher lactate dehydrogenase (LDH) values, multiple brain lesions, more extensive extracranial disease, neurological symptoms, infratentorial lesions and treatment type. Multivariable analysis demonstrated that stereotactic radiotherapy (STRT) was associated with a hazard ratio of 0.401 (p < 0.001) for survival; likewise, immune checkpoint inhibitor therapy was associated with a hazard ratio of 0.375 (p < 0.001). Conclusion: The findings from this study as "real world" data are consistent with results of pivotal clinical trials in MBMs patients and support contemporary locoregional and immunotherapy practices.

中文翻译：

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黑色素瘤脑转移患者临床结果的当代报告

背景：在 40% 以上的 4 期黑色素瘤患者中观察到脑转移。近年来，立体定向放射 (STRT) 的更广泛使用和免疫检查点抑制剂的出现对转移性黑色素瘤脑转移患者的预后产生了积极影响。在这里，我们检查了黑色素瘤脑转移 (MBM) 患者的真实世界临床结果。方法：本回顾性研究评估了 2000 年 4 月至 2017 年 7 月在渥太华医院接受治疗的 MBM 患者。从电子病历中收集临床、放射学、病理学和治疗信息。主要结果是总生存期。生存数据采用比例 Cox 回归模型，而 Fisher' 精确检验和 Mann-Whitney U 检验分别分析了分类数据和连续数据之间的关系。结果：这项回顾性研究包括 276 名患者。191 名患者（69.2%）有症状地检测到脑转移；常规筛查的检出率在 2012 年之前为 4.6%，在当代为 11.7%（p = 0.029）。中位生存期为三个月。总生存期的预测因素是年龄、较高的乳酸脱氢酶 (LDH) 值、多个脑部病变、更广泛的颅外疾病、神经系统症状、幕下病变和治疗类型。多变量分析表明立体定向放疗 (STRT) 与生存风险比为 0.401 (p < 0.001) 相关；同样，免疫检查点抑制剂治疗的风险比为 0.375（p < 0. 001）。结论：这项研究的结果作为“真实世界”数据与 MBM 患者的关键临床试验结果一致，并支持当代局部区域和免疫治疗实践。