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.
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