Prognostic Factors for 12-Week Mortality and 1-Year Survival on a Prospective Cohort of 200 Surgically Treated Brain Metastasis

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.

Objective: 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 an 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: There was a total 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).

Conclusion: Adjuvant RDT and post-operative KPS, added to the 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 more than one year.