A new preoperative scoring system to predict overall survival in patients undergoing surgical removal of brain...

The prognosis for patients with cancer with brain metastasis (BM) requiring surgical removal is relatively limited. Here, we propose a novel predictive scoring system based on preoperative information for overall survival.

The study involved 240 consecutive patients with BM who were treated with surgical removal at our institution between January 2011 and December 2023. Among the 240 patients, we analyzed 185 patients with sufficient blood test data and follow-up. The blood test data, including neutrophils and lymphocytes, were collected for the neutrophil/lymphocyte ratio (NLR).

The multivariate Cox proportional hazards model revealed that age ≥ 65 years, higher NLR ≥ 3.5, preoperative KPS < 80, and extracranial metastasis were unfavorable predictors of prognosis for the patients treated with surgical removal for BM. A 0-5-point scoring system was created, with 1 point assigned to preoperative KPS < 80, age ≥ 65 years, and extracranial metastasis, and 2 points assigned to higher NLR ≥ 3.5. Patients with 0-1, 2-3, and 4-5 points were assigned to groups 1, 2, and 3, respectively. The median survival time from surgery of the entire cohort was 11 months and that of groups 1, 2, and 3 was 44.3, 14.1, and 5.3 months, respectively. The three groups had significantly different median survival times (p < 0.001), with higher scores corresponding to shorter survival times.

Our new predictive scoring system is a simple and highly feasible model that can be used to predict overall survival in patients with BM requiring surgical removal.