Prognostic Factors Impacting Surgical Resection Outcomes in Elderly Patients With Brain Metastasis

Brain metastases (BM) among elderly patients with cancer are increasing, and decision-making for treatment is complicated by comorbidities. This study aimed to identify prognostic factors that can help make informed decisions regarding surgical resection in elderly patients with BM. We retrospectively included elderly patients (65 years or older) with newly diagnosed BM who underwent surgery. We conducted survival analyses and Cox regression analyses to identify potential independent predictors of poor survival. A total of 124 elderly patients with BM undergoing surgical resection were enrolled. In the multivariate analysis, male sex (HR: 1.96, 95% CI: 1.22-3.13), ECM (HR: 2.97, 95% CI: 1.82-4.85), BM in eloquent locations (HR: 1.64, 95% CI: 1.02-2.64), KPS deterioration (HR: 1.93, 95% CI: 1.20-3.10), and mFI-5 equal to or greater than 2 (HR: 2.10, 95% CI: 1.12-3.95) were associated with poor overall survival. Conversely, receiving systemic treatment after the diagnosis of BM showed a significant overall survival benefit (HR: 0.45, 95% CI: 0.28-0.70). Elevated SII (HR: 1.99, 95% CI: 1.02-3.90) was significantly associated with poor survival, while elevated PNI (HR: 0.56, 95% CI: 0.33-0.94) indicated better survival. Clinicians should adopt a personalized approach when selecting treatment options for elderly patients with BM, considering BM location, the presence of ECM, comorbidities, and suitability for postoperative systemic treatment. Evaluating preoperative nutritional and inflammatory status and monitoring performance status pre- and postoperatively are needed, as these factors may affect prognosis.