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Purpose <p>Resection of brain metastases mitigates mass effect and herniation risk while extending overall survival. This cohort study characterizes recurrence-pattern-specific predictors after resection.</p> Methods <p>This retrospective multicenter study analyzed patients undergoing brain metastasis resection at two academic hospitals (June 2011-April 2022). Recurrence patterns were classified as: cavity recurrence (CR), distant intracranial progression (DICP), leptomeningeal disease (LMD), and overall intracranial progression (ICP). Survival outcomes were assessed via Kaplan-Meier method; independent prognostic factors identified by multivariate Cox regression.</p> Results <p>Median overall survival was not reached (95% CI: 66.8-NR). Median times to progression were: ICP 14.8 months (11.5–18.5), CR 27.7 months (23.2-NR), DICP 18.2 months (15.7–24.8), LMD 46.9 months (26.4-NR). Postoperative radiotherapy(PORT) reduced CR risk (HR = 0.42, <i>p</i> &lt; 0.005), particularly within 3 months (HR = 0.49, <i>p</i> = 0.024) and with whole-brain boost (HR = 0.30, <i>p</i> = 0.024). Oncogene-targeted agents(OGTA) consistently lowered all recurrence risks (CR/DICP/LMD/ICP HR: 0.35–0.54, <i>p</i> &lt; 0.05). Key risk factors included age (HR = 1.03/year), infratentorial location (HR = 1.74), and extracranial metastases (HR = 1.68).</p> Conclusion <p>OGTA significantly reduces overall intracranial recurrence, while PORT provides substantial protection against CR. Standardized multimodal protocols are essential during the perioperative period.</p>

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Navigating heterogeneity in resected brain metastases: molecular stratification and multimodal therapeutic strategies

  • 期刊论文

  • 发表日期：

    2025年10月24日

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  • Xue-Fang Zhang,
  • Ying-Zhi Liang,
  • Hong-yuan Wu,
  • Jia-Luo Chen,
  • Jiao Zhou,
  • Yan Zhang,
  • Xu-Wei Liang,
  • Wen-Huan Zhong,
  • Yuanyuan Chen

摘要

Purpose

Resection of brain metastases mitigates mass effect and herniation risk while extending overall survival. This cohort study characterizes recurrence-pattern-specific predictors after resection.

Methods

This retrospective multicenter study analyzed patients undergoing brain metastasis resection at two academic hospitals (June 2011-April 2022). Recurrence patterns were classified as: cavity recurrence (CR), distant intracranial progression (DICP), leptomeningeal disease (LMD), and overall intracranial progression (ICP). Survival outcomes were assessed via Kaplan-Meier method; independent prognostic factors identified by multivariate Cox regression.

Results

Median overall survival was not reached (95% CI: 66.8-NR). Median times to progression were: ICP 14.8 months (11.5–18.5), CR 27.7 months (23.2-NR), DICP 18.2 months (15.7–24.8), LMD 46.9 months (26.4-NR). Postoperative radiotherapy(PORT) reduced CR risk (HR = 0.42, p < 0.005), particularly within 3 months (HR = 0.49, p = 0.024) and with whole-brain boost (HR = 0.30, p = 0.024). Oncogene-targeted agents(OGTA) consistently lowered all recurrence risks (CR/DICP/LMD/ICP HR: 0.35–0.54, p < 0.05). Key risk factors included age (HR = 1.03/year), infratentorial location (HR = 1.74), and extracranial metastases (HR = 1.68).

Conclusion

OGTA significantly reduces overall intracranial recurrence, while PORT provides substantial protection against CR. Standardized multimodal protocols are essential during the perioperative period.