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Brain metastases in adult patients with melanoma of unknown primary in the Netherlands (2011–2020)

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Abstract

Background

Although patients with melanoma of unknown primary (MUP) have a better prognosis than similar-staged melanoma patients with known primary, the occurrence of brain metastases (BM) entails a serious complication. This study provides an overview of the incidence, treatment patterns, and overall survival (OS) of adult patients with BM-MUP in the Netherlands.

Methods

BM-MUP cases were retrieved from the Netherlands Cancer Registry. Patient, disease and treatment-related characteristics were summarised using descriptive statistics. Overall survival (OS) was calculated by the Kaplan–Meier method, and the impact of prognostic factors on OS was assessed using Cox proportional hazard regression analyses.

Results

Among 1779 MUP patients, 450 were identified as BM-MUP (25.3%). Of these patients, 381 (84.7%) presented with BM along with other metastases, while 69 (15.3%) had BM only. BM-MUP patients were predominantly male (68.2%), and had a median age of 64 years at diagnosis (interquartile range 54–71 years). Over time, the proportion of BM along other metastatic sites increased, and the occurrence of BM decreased (p = 0.01). 1-Year OS improved for the total population, from 30.0% (95% confidence interval (CI): 19.8–40.9%) in 2011–2012 to 43.6% (95%CI: 34.5–52.3%) in 2019–2020, and median OS more than doubled from 4.2 months (95%CI: 3.3–6.2 months) to 9.8 months (95%CI: 7.0–13.2 months). Patient’s age, localisation of BM, presence of synchronous liver metastasis and treatment were identified as independent predictors of OS.

Conclusion

Notwithstanding the progress made in OS for patients with BM-MUP in the past decade, their overall prognosis remains poor, and further efforts are needed to improve outcomes.

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Acknowledgements

The authors thank the Netherlands Comprehensive Cancer Organisation (IKNL) registry team for collecting data for the Netherlands Cancer Registry.

Funding

The authors of this research declare that no funds, grants, or other support were received during the preparation of this manuscript.

Author information

Authors and Affiliations

  1. Department of Medical Oncology, Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, 1066 CX, Amsterdam, The Netherlands

    C. S. Padilla

  2. Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands

    C. S. Padilla, V. K. Y. Ho, T. W. A. N. Mooijenkind, M. W. J. Louwman & C. Loef

  3. Department of Urology, Erasmus MC, Rotterdam, The Netherlands

    T. W. A. N. Mooijenkind

  4. Department of Medical Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands

    F. Y. F. L. de Vos

  5. Department of Dermatology, Cancer Centre Amsterdam / Amsterdam UMC, Amsterdam, The Netherlands

    M. W. Bekkenk

  6. Missie Tumor Onbekend, Patient Organisation, Amsterdam, The Netherlands

    W. A. Minnaard

  7. Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands

    S. E. M. Veldhuijzen van Zanten

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  1. C. S. Padilla
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Contributions

All authors contributed to the study conception and design. Conceptualization: CL, CP, VH; Methodology: CL, CP, VH, TM; Formal analysis and investigation: CL, TM, VH; Writing—original draft preparation: CL, CP, TM, VH; Writing—review and editing: CL, CP, ML, FV, SVZ, TM, WM, VH; Funding acquisition: none; Resources: none; Supervision: CL, VH. All authors read and approved the final manuscript.

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Correspondence to C. S. Padilla.

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Padilla, C.S., Ho, V.K.Y., Mooijenkind, T.W.A.N. et al. Brain metastases in adult patients with melanoma of unknown primary in the Netherlands (2011–2020). J Neurooncol 163, 239–248 (2023). https://doi.org/10.1007/s11060-023-04335-1

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