CC BY-NC-ND 4.0 · Asian J Neurosurg 2023; 18(01): 139-149
DOI: 10.1055/s-0043-1764120
Original Article

Predictors of Survival in Patients with Metastatic Brain Tumors: Experience from a Low-to-Middle-Income Country

Saad Bin Anis
1   Section of Neurosurgery, Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
2   Department of Surgery, Section of Neurosurgery, The Aga Khan University, Karachi, Pakistan
1   Section of Neurosurgery, Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
› Author Affiliations
Funding None.


Objective The interplay of static factors and their effect on metastatic brain tumor survival, especially in low-to-middle-income countries (LMICs), has been rarely studied. To audit our experience, and explore novel survival predictors, we performed a retrospective analysis of brain metastases (BM) patients at Shaukat Khanum Memorial Cancer Hospital (SKMCH), Pakistan.

Materials and Methods A retrospective review was conducted of consecutive patients who presented with BM between September 2014 and September 2019 at SKMCH. Patients with incomplete records were excluded.

Statistical Analysis SPSS (v.25 IBM, Armonk, New York, United States) was used to collect and analyze data via Cox-Regression and Kaplan–Meier curves.

Results One-hundred patients (mean age 45.89 years) with confirmed BM were studied. Breast cancer was the commonest primary tumor. Median overall survival (OS) was 6.7 months, while the median progression-free survival (PFS) was 6 months. Age (p = 0.001), gender (p = 0.002), Eastern Cooperative Oncology Group (p < 0.05), anatomical site (p = 0.002), herniation (p < 0.05), midline shift (p = 0.002), treatment strategies (p < 0.05), and postoperative complications (p < 0.05) significantly impacted OS, with significantly poor prognosis seen with extremes of age, male gender (hazard ratio [HR]: 2.0; 95% confidence interval [CI]: 1.3–3.1; p = 0.003), leptomeningeal lesions (HR: 5.7; 95% CI: 1.1–29.7; p = 0.037), and patients presenting with uncal herniation (HR: 3.5; 95% CI: 1.9–6.3; p < 0.05). Frontal lobe lesions had a significantly better OS (HR: 0.5; 95% CI: 0.2–1.0; p = 0.049) and PFS (HR: 0.08; 95% CI: 0.02–0.42; p = 0.003).

Conclusion BM has grim prognoses, with comparable survival indices between developed countries and LMICs. Early identification of both primary malignancy and metastatic lesions, followed by judicious management, is likely to significantly improve survival.

Authors' Contributions

SBA contributed to study conceptualization, data collection and analysis, and approval of the final manuscript. UHT helped in data collection and analysis, literature review, and developing and finalizing the manuscript. IY was involved in study supervision and conceptualization, approval of the final manuscript.

Ethical Review

The study was approved by the IRB at Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan.


This manuscript was accepted to be presented as digital poster in the American Association of Neurological Surgeons (AANS) Meeting, April 25–29, 2020, in Boston, USA.

Publication History

Article published online:
28 March 2023

© 2023. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

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