title: Number of metastases, serum lactate dehydrogenase level, and type of treatment are prognostic factors in patients with brain metastases of malignant melanoma.
abstract: BACKGROUND
  This multicenter study aimed to identify prognostic factors in patients with brain metastases from malignant melanoma (BM-MM).
  
  
  METHODS
  In a retrospective survey in 9 cancer centers of the German Cancer Society, 692 patients were identified with BM-MM during the period 1986 through 2007. Overall survival was analyzed using a Kaplan-Meier estimator and compared with log-rank analysis. Cox proportional hazards models were used to identify prognostic factors significant for survival.
  
  
  RESULTS
  The median overall survival of the entire cohort was 5.0 months (95% confidence interval [95% CI], 4 months-5 months). Significant prognostic factors in the univariate Kaplan-Meier analysis were Karnofsky performance status (≥70% vs <70%; P < .001), number of BM-MM (single vs multiple; P < .001), pretreatment levels of lactate dehydrogenase (LDH) (normal vs elevated; P < .001) and S-100 (normal vs elevated; P < .001), prognostic groups according to Radiation Therapy Oncology Group (class I vs class II vs class III; P = .0485), and treatment choice (for the cohort with single BM-MM only) (stereotactic radiotherapy or neurosurgical metastasectomy vs others; P = .036). Cox proportional hazards models revealed pretreatment elevated level of serum LDH (hazard ratio [HR], 1.6; 95% CI, 1.3-2.0 [P = .00013]) and number of BM-MM (HR, 1.6; 95% CI, 1.3-2.0 [P = .00011]) to be independent prognostic variables in the entire cohort, whereas in patients with a single BM-MM, treatment choice (HR, 1.5; 95% CI, 1.1-1.9 [P = .0061]) was identified as a unique prognostic factor.
  
  
  CONCLUSIONS
  The overall survival of patients with BM-MM primarily depends on the number of metastases and pretreatment level of LDH. In the case of a single brain metastasis, stereotactic radiotherapy or neurosurgical metastasectomy is by far the most important factor for improving survival.
authors.affiliation: Division of Dermatooncology, Department of Dermatology, University Hospital Tuebingen, Tuebingen, Germany.
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Eigentler
authors.forename: Adina
authors.initials: A
authors.lastname: Figl
authors.forename: Dietmar
authors.initials: D
authors.lastname: Krex
authors.forename: Peter
authors.initials: P
authors.lastname: Mohr
authors.forename: Cornelia
authors.initials: C
authors.lastname: Mauch
authors.forename: Knut
authors.initials: K
authors.lastname: Rass
authors.forename: Azize
authors.initials: A
authors.lastname: Bostroem
authors.forename: Oliver
authors.initials: O
authors.lastname: Heese
authors.forename: Oliver
authors.initials: O
authors.lastname: Koelbl
authors.forename: Claus
authors.initials: C
authors.lastname: Garbe
authors.forename: Dirk
authors.initials: D
authors.lastname: Schadendorf
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery / Q000628:therapy; D002648:Child; D005260:Female; D006801:Humans; D066298:In Vitro Techniques; D007770:L-Lactate Dehydrogenase / Q000097:blood*; D008545:Melanoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery / Q000628:therapy; D008875:Middle Aged; D011379:Prognosis; D012878:Skin Neoplasms / Q000473:pathology; D016019:Survival Analysis
chemical_list: D007770:L-Lactate Dehydrogenase