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Background <p>Brain metastases affect 10–20% of cancer patients, yet the perioperative factors most strongly governing recurrence after surgical resection remain poorly characterised. This study aims to identify the perioperative determinants of recurrence of brain metastases.</p> Methods <p>We conducted a retrospective cohort study of patients undergoing resection of histologically confirmed brain metastases between January 2010 and June 2024. Eligible patients were ≥ 18 years who survived to discharge and had complete surgical outcome records. Data were collected at patient and lesion levels, capturing demographics, tumour characteristics, extent of resection, resection technique, and capsule status. Outcomes were stratified by primary tumour origin using Kaplan-Meier and log-rank analysis, followed by clustered multivariable Cox proportional hazards regression to identify independent predictors of progression-free survival (PFS).</p> Results <p>172 patients were included (361 total lesions, 247 resected). The three most common primary origins were lung (<i>n</i> = 70), breast (<i>n</i> = 42), and renal cell carcinoma (RCC, <i>n</i> = 31). RCC demonstrated significantly shorter time to recurrence than lung cancer (<i>p</i> = 0.0298) and melanoma (<i>p</i> = 0.0441), while lung cancer was associated with fewer minor complications than breast (<i>p</i> = 0.0329) and colon cancer (<i>p</i> = 0.0471). No significant differences in overall survival were observed. On multivariable Cox regression, younger age (HR = 0.97 per year), lesion size (HR = 1.03 per mm), piecemeal resection (HR = 2.22), and subtotal resection (HR = 2.21) independently predicted worse PFS. Breast cancer origin (HR = 0.54) and radiotherapy were significantly protective (HR = 0.37). Intraoperative capsule breach was the most influential modifiable predictor (HR = 2.70).</p> Conclusion <p>Capsule integrity and resection technique are key modifiable determinants of recurrence following brain metastasis surgery, with implications for surgical planning and adjuvant therapy selection.</p>

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Perioperative determinants of oncologic trajectory shaping recurrence and survival following resection of brain metastases

  • 期刊论文

  • 发表日期：

    2026年6月24日

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  • Yash Akkara,
  • Ping Ping Wang,
  • Joshua J. Hon,
  • Archie Egrilmezer,
  • Wasit Tahami,
  • Nigel Mendoza,
  • Joe M. Das

摘要

Background

Brain metastases affect 10–20% of cancer patients, yet the perioperative factors most strongly governing recurrence after surgical resection remain poorly characterised. This study aims to identify the perioperative determinants of recurrence of brain metastases.

Methods

We conducted a retrospective cohort study of patients undergoing resection of histologically confirmed brain metastases between January 2010 and June 2024. Eligible patients were ≥ 18 years who survived to discharge and had complete surgical outcome records. Data were collected at patient and lesion levels, capturing demographics, tumour characteristics, extent of resection, resection technique, and capsule status. Outcomes were stratified by primary tumour origin using Kaplan-Meier and log-rank analysis, followed by clustered multivariable Cox proportional hazards regression to identify independent predictors of progression-free survival (PFS).

Results

172 patients were included (361 total lesions, 247 resected). The three most common primary origins were lung (n = 70), breast (n = 42), and renal cell carcinoma (RCC, n = 31). RCC demonstrated significantly shorter time to recurrence than lung cancer (p = 0.0298) and melanoma (p = 0.0441), while lung cancer was associated with fewer minor complications than breast (p = 0.0329) and colon cancer (p = 0.0471). No significant differences in overall survival were observed. On multivariable Cox regression, younger age (HR = 0.97 per year), lesion size (HR = 1.03 per mm), piecemeal resection (HR = 2.22), and subtotal resection (HR = 2.21) independently predicted worse PFS. Breast cancer origin (HR = 0.54) and radiotherapy were significantly protective (HR = 0.37). Intraoperative capsule breach was the most influential modifiable predictor (HR = 2.70).

Conclusion

Capsule integrity and resection technique are key modifiable determinants of recurrence following brain metastasis surgery, with implications for surgical planning and adjuvant therapy selection.