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Objectives <p>This study aimed to evaluate the survival outcomes and identify prognostic factors in patients undergoing surgical resection for brain metastases (BMs), with a particular focus on the impact of surgical techniques and multimodal therapy sequences.</p> Methods <p>We conducted a retrospective analysis of 228 consecutive patients who underwent neurosurgical resection for BMs at a single institution (2012–2020). Primary endpoints were median overall survival (mOS) and survival rates, analyzed via Kaplan-Meier methodology. Prognostic factors were assessed using univariate and multivariate Cox proportional hazards models, with subgroup analyses based on primary tumor origin.</p> Results <p>The cohort’s overall mOS was 14 months, with 1-, 2-, and 3-year survival rates of 60.3%, 35.4%, and 23.2%, respectively. Multivariate analysis identified preoperative Karnofsky Performance Status (KPS) as a powerful independent prognostic factor (Hazard Ratio [HR] = 49.076, 95% Confidence Interval [CI]: 21.483–112.110, <i>P</i> &lt; 0.001). The treatment modality significantly influenced survival: patients receiving postoperative radiotherapy achieved an mOS of 18 months, compared to 13 months for surgery alone. Strikingly, the cohort receiving combined pre- and postoperative radiotherapy (<i>n</i> = 6) demonstrated a superior mOS of 41 months. In lung cancer BMs (<i>n</i> = 109, mOS = 11 months), targeted therapy was associated with a significantly prolonged mOS of 28 months versus 10 months in non-recipients. For breast cancer BMs (<i>n</i> = 26, mOS = 17 months), chemotherapy was an independent favorable prognostic factor (HR = 6.297, <i>P</i> = 0.009).</p> Conclusions <p>Surgical resection, particularly when integrated into a multimodal strategy, confers significant survival benefits for patients with BMs. The sequence of therapy is critical, with combined perioperative radiotherapy emerging as a highly promising regimen. Preoperative KPS is a paramount prognosticator. These findings advocate for an aggressive, personalized surgical approach embedded within a comprehensive neuro-oncological framework.</p>

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Surgical outcomes and prognostic factors in 228 patients with brain metastases: a focus on en bloc resection and multimodal therapy

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月20日

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  • Peng Sun,
  • Chunyu Gu,
  • Haoran Wang,
  • Yanzhen Zhang,
  • Jianping Cao,
  • Junpeng Ji,
  • Mingshan Zhang

摘要

Objectives

This study aimed to evaluate the survival outcomes and identify prognostic factors in patients undergoing surgical resection for brain metastases (BMs), with a particular focus on the impact of surgical techniques and multimodal therapy sequences.

Methods

We conducted a retrospective analysis of 228 consecutive patients who underwent neurosurgical resection for BMs at a single institution (2012–2020). Primary endpoints were median overall survival (mOS) and survival rates, analyzed via Kaplan-Meier methodology. Prognostic factors were assessed using univariate and multivariate Cox proportional hazards models, with subgroup analyses based on primary tumor origin.

Results

The cohort’s overall mOS was 14 months, with 1-, 2-, and 3-year survival rates of 60.3%, 35.4%, and 23.2%, respectively. Multivariate analysis identified preoperative Karnofsky Performance Status (KPS) as a powerful independent prognostic factor (Hazard Ratio [HR] = 49.076, 95% Confidence Interval [CI]: 21.483–112.110, P < 0.001). The treatment modality significantly influenced survival: patients receiving postoperative radiotherapy achieved an mOS of 18 months, compared to 13 months for surgery alone. Strikingly, the cohort receiving combined pre- and postoperative radiotherapy (n = 6) demonstrated a superior mOS of 41 months. In lung cancer BMs (n = 109, mOS = 11 months), targeted therapy was associated with a significantly prolonged mOS of 28 months versus 10 months in non-recipients. For breast cancer BMs (n = 26, mOS = 17 months), chemotherapy was an independent favorable prognostic factor (HR = 6.297, P = 0.009).

Conclusions

Surgical resection, particularly when integrated into a multimodal strategy, confers significant survival benefits for patients with BMs. The sequence of therapy is critical, with combined perioperative radiotherapy emerging as a highly promising regimen. Preoperative KPS is a paramount prognosticator. These findings advocate for an aggressive, personalized surgical approach embedded within a comprehensive neuro-oncological framework.