Number of metastases, serum lactate dehydrogenase level, and type of treatment are prognostic factors in patients with brain metastases of malignant melanoma

Cancer. 2011 Apr 15;117(8):1697-703. doi: 10.1002/cncr.25631. Epub 2010 Nov 8.


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.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Brain Neoplasms / mortality
  • Brain Neoplasms / secondary*
  • Brain Neoplasms / surgery
  • Brain Neoplasms / therapy
  • Child
  • Female
  • Humans
  • In Vitro Techniques
  • L-Lactate Dehydrogenase / blood*
  • Melanoma / mortality
  • Melanoma / secondary*
  • Melanoma / surgery
  • Melanoma / therapy
  • Middle Aged
  • Prognosis
  • Skin Neoplasms / pathology
  • Survival Analysis


  • L-Lactate Dehydrogenase