Prognostic factors following resection of intracranial metastases

Abstract

Background: The aim of this study was to identify prognostic factors associated with resection of intracranial metastases.

Methods: A retrospective case series including patients who underwent resection of cranial metastases from March 2014 to April 2021 at a single center. This identified 112 patients who underwent 124 resections. The median age was 65 years old (24-84) and the most frequent primary cancers were nonsmall cell lung cancer (56%), breast adenocarcinoma (13%), melanoma (6%), and colorectal adenocarcinoma (6%). Postoperative MRI with contrast was performed within 48 hours in 56% of patients and radiation treatment was administered in 41%. GraphPad Prism 9.2.0 was used for the survival analysis.

Results: At the time of data collection, 23% were still alive with a median follow-up of 1070 days (68-2484). The 30- and 90-day, and 1- and 5-year overall survival rates were 93%, 83%, 35%, and 17%, respectively. The most common causes of death within 90 days were as follows: unknown (32%), systemic or intracranial disease progression (26%), and pneumonia (21%). Age and extent of neurosurgical resection were associated with overall survival (P < 0.05). Patients aged >70 had a median survival of 5.4 months compared with 9.7, 11.4, and 11.4 for patients <50, 50-59, and 60-69, respectively. Gross-total resection achieved an overall survival of 11.8 months whereas sub-total, debulking, and unclear extent of resection led to a median survival of 5.7, 7.0, and 9.0 months, respectively.

Conclusion: Age and extent of resection are potential predictors of long-term survival.

Keywords: Brain metastasis; Breast cancer; Nonsmall cell lung cancer; Stereotactic radiosurgery; Whole-brain radiotherapy.

Figure 1:

Kaplan–Meier graphs for survival analysis including all patients and then stratified by gender, age, and multiplicity of intracranial disease (median survivals and P values are displayed in Table 6).

Figure 2:

Kaplan–Meier graph for survival analysis stratified by histological diagnosis, adjuvant radiation treatment, and extent of neurosurgical resection (median survivals and P values are displayed in Table 6).

Figure 3:

Recursive partitioning analysis using age and extent of resection. GTR: Gross-total resection.

Supplementary Figure 1:

Bar charts showing multiplicity of intracranial disease, day postoperative MRI performed and extent of resection and adjuvant radiation treatment.