gms | German Medical Science

Objective: Brain metastases represent the most critical neurological complication in cancer patients. Recent evidence suggests that the incidence of brain metastases is on the rise, which may be explained by the availability of more efficient cancer treatment regimens. Very often, the treating team faces the challenge of deciding whether a patient harboring brain metastases should be operated on or not. This decision would clearly benefit from individual patients’ predicted survival. Although numerous prognostic factors have been described for these patients, there is little consensus regarding which works best. Identifying the most efficient way to determine prognosis could help professionals make a more confident and well-informed decision regarding the choice to operate patients on a case-by-case basis. With the aim of identifying the best prognostic factors, we assessed the correlation between 16 patient-specific criteria and survival length in a group of 85 patients with multiple brain metastases who were submitted to surgical lesion resection at our institution.

Methods: A group of 85 patients harboring brain metastases and submitted to neurosurgical treatment at our institution from 2008 to 2012 were enrolled in this retrospective analysis. We identified subgroups with short (death < 2 months after surgery) versus longer (>1 year) survival and assessed their correlation with the following 16 variables: age, sex, body mass index (BMI), histological type, pre-operative Karnofsky Performance Scale (KPS) score, platelet number, lactate dehydrogenase level, time between cancer diagnosis and brain surgery, presence of extra-cranial disease, number of intracranial lesions, Graded Prognostic Assessment (GPA), post-operative radiation, radiological pattern, presence of a lesion in the posterior fossa, volume of the larger intracranial lesion, and presence of neurological symptoms at the time of diagnosis.

Results: Pre-operative KPS score was significantly associated with both short (< 2 months; p<0.001) and longer (> 1 year; p<0.05) survival, as was post-operative (whole brain) irradiation (p<0.001 for the <2 month group and p<0.05 for the >1 year group). Furthermore, the multiple logistic regression model revealed that both KPS score and symptom duration were protective factors in the <2 months group (OR 0.93; 95%CI 0.90-0.97, and 0.19; 95%CI 0.05-0.68, respectively).

Conclusion: Among the various clinical, oncological and radiological criteria we assessed, the two factors most significantly associated with both short and longer survival rates after surgery were the patient's pre-operative functional status (based on the KPS score) and the use of post-operative whole brain radiotherapy. We conclude that KPS is the best prognostic factor for patients with multiple brain metastases and should therefore be used to determine the need for surgical resection.