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. 2023 Jan;165(1):231-238.
doi: 10.1007/s00701-022-05356-x. Epub 2022 Sep 24.

Surgery for brain metastases: radiooncology scores predict survival-score index for radiosurgery, graded prognostic assessment, recursive partitioning analysis

Christina Wolfert  1 , Veit Rohde  1 , Abdelhalim Hussein  1 , Ingo Fiss  1 , Silvia Hernández-Durán  1 , Dörthe Malzahn  2 , Annalen Bleckmann  3   4 , Dorothee Mielke  1 , Bawarjan Schatlo  5
Affiliations

Surgery for brain metastases: radiooncology scores predict survival-score index for radiosurgery, graded prognostic assessment, recursive partitioning analysis

Christina Wolfert et al. Acta Neurochir (Wien). 2023 Jan.

Abstract

Background: Radiooncological scores are used to stratify patients for radiation therapy. We assessed their ability to predict overall survival (OS) in patients undergoing surgery for metastatic brain disease.

Methods: We performed a post-hoc single-center analysis of 175 patients, prospectively enrolled in the MetastaSys study data. Score index of radiosurgery (SIR), graded prognostic assessment (GPA), and recursive partitioning analysis (RPA) were assessed. All scores consider age, systemic disease, and performance status prior to surgery. Furthermore, GPA and SIR include the number of intracranial lesions while SIR additionally requires metastatic lesion volume. Predictive values for case fatality at 1 year after surgery were compared among scoring systems.

Results: All scores produced accurate reflections on OS after surgery (p ≤ 0.003). Median survival was 21-24 weeks in patients scored in the unfavorable cohorts, respectively. In cohorts with favorable scores, median survival ranged from 42 to 60 weeks. Favorable SIR was associated with a hazard ratio (HR) of 0.44 [0.29, 0.66] for death within 1 year. For GPA, the HR amounted to 0.44 [0.25, 0.75], while RPA had a HR of 0.30 [0.14, 0.63]. Overall test performance was highest for the SIR.

Conclusions: All scores proved useful in predicting OS. Considering our data, we recommend using the SIR for preoperative prognostic evaluation and counseling.

Keywords: Cerebral metastasis; Neurooncology; Scores; Surgery for brain tumors; Survival.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Preoperative SIR, GPA, and RPA predict long-term survival after surgical resection of brain metastasis. Overall survival in a surgical cohort (n = 175), stratified by the SIR (left), GPA (middle) and RPA (right). Within scoring systems, pairwise group comparisons (p-values) were obtained with respect to the group with worst outcome (black dotted lines: SIR class 1, GPA class 1, RPA class 3). See Table 2 for details
Fig. 2
Fig. 2
Postoperative radiotherapy and the SIR. The SIR distinguished long-term survival outcome especially in patients with postoperative radiotheray (left panel: 86% of the cohort, n = 151: 44 with SIR-1, 45 with SIR-2, 57 with SIR-3, 5 with SIR-4). Only few patients had received no postoperative radiotherapy (right panel: 14%, n = 24: 15 with SIR-1, 4 with SIR-2, 5 with SIR-3, none with SIR-4). For details, see Table 3
See this image and copyright information in PMC

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