Factors Associated with Overall Survival (OS) and 90-day Mortality Following Resection of Melanoma Brain metastases (MBMs)

Introduction: Many surgical studies on brain metastases focus on patients with limited lesions, include multiple pathologies and lack volumetric analyses. Although brain metastases are common in melanoma, few studies are dedicated to surgical outcomes in this specific population. We examined clinical factors associated with outcomes in MBM patients undergoing first-time surgical resection.

Methods: A retrospective review was performed of patients undergoing resection for MBM(s) at MD Anderson Cancer Center. Patients previously treated with radiation therapy were excluded. Demographics, radiographic, and clinical factors were collected. Pre- and post-operative tumor burden and extent of resection were determined by computerized volumetric analysis. Logistic and Cox proportional hazards regressions were used to identify associations with 90-day mortality and OS, respectively.

Results: We identified 105 MBM surgical patients for analysis (median follow-up, 66 months). Forty-nine patients (47%) had multiple metastases at time of surgery. Diagnosis of brain metastasis was synchronous with stage 4 diagnosis in 43 (46%); 58 (66%) had uncontrolled systemic disease at time of resection. Median pre-operative and post-operative Karnofsky Performance Scale score (KPS) were 80 (range, 30-100) and 90 (range, 50-100) respectively. 30-day and 90-day post-operative mortality rates were 3% and 19% respectively. In multivariate analysis, 90-day mortality was associated with brain metastasis at time of stage 4 diagnosis (p = 0.003) and post-op KPS (p = 0.009). Median OS was 9.8 months. Multivariate analysis showed that: brain metastasis at stage 4 diagnosis (p = 0.011), post-operative radiosurgery (p = 0.013), post-operative residual tumor (p = 0.002) and post-operative KPS (p= 0.008) were associated with post-operative OS

Conclusion : MBM is a common sequala of advanced melanoma. Here we identify key factors associated with overall survival in surgical MBM patients. Deeper understanding of the variables impacting outcome and post-op mortality may be beneficial in surgical decision making