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  • Prognostic Factors for 12-week Mortality and 1-year Survival on a Prospective Cohort of 200 Surgically Treated Brain Metastasis

    Final Number:

    Davi Jorge Fontoura Solla MD; Helder Picarelli MD; Marcelo de Lima Oliveira; Eberval Gadelha; Manoel Jacobsen Teixeira

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Brain metastasis (BM) prognosis has improved due to advances on the systemic treatment, neurosurgical techniques and radiotherapy. Prognostic scores specific for BM were developed at least a decade ago. Our objective was to evaluate the survival of BM surgically treated and identify prognostic factors on a contemporary cohort. Perioperative morbidity and mortality were also evaluated.

    Methods: Surgically treated BM prospectively followed-up at oncology center of a tertiary university hospital. Factors independently associated with 1-year survival and 12-week mortality after adjustment for the GPA score were identified through Cox regression and logistic regression models respectively. GPA variables were not considered for the multivariate models.

    Results: It were included 200 patients (mean age 56.1±12.6 years, 55.0% female, 36.5% lung cancer). A 48.0% had >1 BM and 27.5% were on eloquent areas. Preoperative median KPS was 60 (quartiles 50-80) and GPA 1.5 (quartiles 1-2). Gross total resection was achieved on 89.0% and 63.0% were submitted to adjuvant radiotherapy (RDT). Infection (surgical/systemic) was the main perioperative morbidity (13.0%) and the cause of 62.5% 28-day deaths. The 12-week and 28-day mortality were 30,5% and 8,0%. Median survival was 5 months and 34.5% lived >1 year. Postoperative KPS improved to a median 80 (quartiles 60-90) (55.0% improved). After multivariate adjustment, including GPA score, RDT (OR 0.22, 95%CI 0.10-0.48,p<0.0001) and postoperative KPS (each 10-point improvement, OR 0.60, 95%CI 0.48-0.82,p<0.001) were associated with 12-week mortality. One year survival was associated with preoperative ASA (HR 1.46, 95%CI 1.11-1.92,p=0.007), left-sided (HR 1.69, 95%CI 1.05-2.72,p=0.029) or bilateral lesions (HR 2.24, 95%CI 1.40-3.56,p=0.001), RDT (HR 0.42, 95%CI 0.28-0.64,p<0.001) and postoperative KPS (each 10-point, HR 0.70, 95%CI 0.62-0.78,p<0.001).

    Conclusions: Adjuvant RDT and post-operative KPS, added to GPA, played a major role on 12-week and 1-year prognosis. Although morbidity and mortality remain high, functionality improved after surgical resection and more than one third lived for >1 year.

    Patient Care: Recognizing current prognosis on brain metastasis helps better inform patient and families about treatment expectations, specially adjuvant radiotherapy, and regarding postoperative KPS.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe prognostic factors for brain metastasis patients survival; 2) Discuss how brain metastasis prognosis has improved along the years.

    References: - Nieder C, Spanne O, Mehta MP, Grosu AL,Geinitz H. Presentation, patterns of care, and survival in patients with brain metastases: What has changed in the last 20 years? Cancer. 2011 Jun 1;117(11):2505-12. - Owonikoko TK, Arbiser J, Zelnak A, Shu HK, Shim H, Robin AM, Kalkanis SN, Whitsett TG, Salhia B, Tran NL, Ryken T, Moore MK, Egan KM,Olson JJ. Current approaches to the treatment of metastatic brain tumours. Nat Rev Clin Oncol. 2014 Apr;11(4):203-22. - Schödel P, Schebesch K-M, Brawanski A, Proescholdt MA. Surgical Resection of Brain Metastases—Impact on Neurological Outcome. International Journal of Molecular Sciences. 2013;14(5):8708-8718.

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