Factors Associated With Overall Survival and 90-Day Mortality Following Resection of Melanoma Brain Metastases

Surgical decision making in patients with brain metastasis is complex, particularly for patients with melanoma brain metastasis (MBM). Few studies specifically address neurosurgical outcomes based on histology. This study aims to identify clinical factors associated with early mortality and overall survival (OS) after tumor resection in patients with MBM.

Patients diagnosed with MBM from 2009 to 2018 at our institution who underwent surgical resection as their first-line therapy were included in the study. The primary outcomes were postoperative OS, 90-day mortality, and leptomeningeal disease (LMD) incidence. Associations between OS and postoperative 90-day mortality with demographic/clinical factors were assessed using Cox proportional hazards regression models and logistic regression models, respectively. The cumulative incidence of LMD was determined using competing risks, and associations with demographic/clinical factors were assessed using proportional subdistribution hazards regression models.

A total of 103 patients with MBM were included. Ninety-day mortality occurred in 18% (n = 19). Elevated lactate dehydrogenase at MBM diagnosis (odds ratio [OR] [95% CI]: OR = 7.17 [1.50-34.25]; P = .013) was associated increased odds of early mortality in multivariable analysis. Postoperative Karnofsky Performance Scale ≥80 (OR = 0.13 [0.03-0.62]; P = .010) and MBM at stage 4 diagnosis (OR = 0.11 [0.02-0.67]; P = .016) were associated with reduced odds of early mortality. Factors associated with better postoperative OS (hazard ratio [HR] [95% CI]) included synchronous diagnosis of MBM and stage 4 disease (HR = 0.59 [0.36-0.95]; P = .032), preoperative Karnofsky Performance Scale ≥80 (HR = 0.46 [0.27-0.80]; P = .006), adjuvant stereotactic radiosurgery (HR = 0.55 [0.32-0.93]; P = .026), and surgical reduction of volumetric intracranial tumor burden ≥95.6% (HR = 0.47 [0.28-0.80]; P = .005). No factors were significantly associated with cumulative incidence of LMD.

This is the largest analysis of patients with MBM who underwent surgery as first-line therapy. We identified clinical factors associated with early postoperative mortality and survival including surgical reduction of intracranial tumor burden.