Risk Stratification and Clinical Outcomes for Surgically Treated Brain Metastasis: A Single Institutional Experience...

Area of Science:

• Neurosurgery
• Oncology
• Cancer Research

Background:

• Brain metastases (BMs) are a major cause of mortality in cancer patients.
• Surgical resection is standard for large or symptomatic BMs, but prognostic stratification is challenging.
• Existing models do not fully incorporate modern immune and targeted therapies.

Purpose of the Study:

• Identify independent prognostic factors for surgical resection of BMs.
• Share institutional experience on surgical outcomes and multimodal management of BMs.
• Develop a predictive model for overall survival in patients with BMs.

Main Methods:

• Analysis of 301 patients who underwent surgical resection for BMs (2020-2022).
• Univariate and multivariate Cox regression analyses to identify predictors of overall survival (OS).
• Construction and validation of a statistical nomogram to visualize prognostic parameters.

Main Results:

• Negative OS predictors: infratentorial location (HR 1.896), multiple metastases (HR 1.194), and age (HR 1.018).
• Protective factors: postoperative immune/targeted therapy (HR 0.361), adjuvant WBRT (HR 0.671), and higher discharge KPS (HR 0.983).
• Validated nomogram demonstrated good internal discrimination (C-index 0.692).

Conclusions:

• Surgical resection of BMs is safe and effective for carefully selected patients.
• Strict risk stratification is essential, considering tumor location, burden, and systemic therapies.
• Optimizing outcomes for BMs requires integrating modern therapies into risk stratification.