Open Access
CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2018; 37(S 01): S1-S332
DOI: 10.1055/s-0038-1672789
E-Poster – Oncology
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Prognostic Factors for 12-Week Mortality and 1-Year Survival on a Prospective Cohort of 200 Surgically Treated Brain Metastasis

Authors

  • Davi Jorge Fontoura Solla

    1   Universidade de São Paulo (USP)

  • Hélder Picarelli

    1   Universidade de São Paulo (USP)

  • Marcelo de Lima Oliveira

    1   Universidade de São Paulo (USP)

  • Eberval Gadelha Figueiredo

    1   Universidade de São Paulo (USP)

  • Manoel Jacobsen Teixeira

    1   Universidade de São Paulo (USP)
Further Information

Publication History

Publication Date:
06 September 2018 (online)

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    Introduction: Brain metastasis (BM) prognosis has improved due to advances on the systemic treatment, neurosurgical techniques and radiotherapy. Prognostic scores specific for BM were developed at least a decade ago.

    Objective: Our objective was to evaluate the survival of BM surgically treated and identify prognostic factors on a contemporary cohort. Perioperative morbidity and mortality were also evaluated.

    Methods: Surgically treated BM prospectively followed-up at an oncology center of a tertiary university hospital. Factors independently associated with 1-year survival and 12-week mortality after adjustment for the GPA score were identified through Cox regression and logistic regression models respectively. GPA variables were not considered for the multivariate models.

    Results: There was a total 200 patients (mean age 56.1 ± 12.6 years, 55.0% female, 36.5% lung cancer). A 48.0% had > 1 BM and 27.5% were on eloquent areas. Preoperative median KPS was 60 (quartiles 50–80) and GPA 1.5 (quartiles 1–2). Gross total resection was achieved on 89.0% and 63.0% were submitted to adjuvant radiotherapy (RDT). Infection (surgical/systemic) was the main perioperative morbidity (13.0%) and the cause of 62.5% 28-day deaths. The 12-week and 28-day mortality were 30,5% and 8,0%. Median survival was 5 months and 34.5% lived > 1 year. Postoperative KPS improved to a median 80 (quartiles 60–90) (55.0% improved). After multivariate adjustment, including GPA score, RDT (OR 0.22, 95% CI 0.10–0.48, p < 0.0001) and postoperative KPS (each 10-point improvement, OR 0.60, 95% CI 0.48–0.82, p < 0.001) were associated with 12-week mortality. One year survival was associated with preoperative ASA (HR 1.46, 95% CI 1.11–1.92, p = 0.007), left-sided (HR 1.69, 95%CI 1.05–2.72, p = 0.029) or bilateral lesions (HR 2.24, 95% CI 1.40–3.56, p = 0.001), RDT (HR 0.42, 95% CI 0.28–0.64, p < 0.001) and postoperative KPS (each 10-point, HR 0.70, 95% CI 0.62–0.78, p < 0.001).

    Conclusion: Adjuvant RDT and post-operative KPS, added to the GPA, played a major role on 12-week and 1-year prognosis. Although morbidity and mortality remain high, functionality improved after surgical resection and more than one third lived for more than one year.


     

    No conflict of interest has been declared by the author(s).