Benefit of primary and repeated surgery on survival in patients with multiple brain metastases
André Norbert Josef Sagerer (Dresden), Michael Lucas (Dresden), Ilker Y. Eyüpoglu (Dresden), Silke Hennig (Dresden), Gabriele Schackert (Dresden), Tareq Juratli (Dresden)
Primary and repeated surgical resection of brain metastases (BM) alleviates symptoms and can improve patients" survival. However, the benefit of resecting multiple BM, particularly of recurrent ones, is controversial due to patients" limited life expectancy. This study evaluates the impact of resecting multiple BM on patients" survival.
Clinical data from 533 patients (211 female, 322 male) who underwent BM surgery at our hospital within 12 years were reviewed. Overall (OS) and progression-free (PFS) survival were estimated using the Kaplan-Meier estimator. In addition, follow-up data, adjuvant treatment and tumor recurrence were collected.
Of the patients, 268 (50.3%) had a single BM, 112 (21%) had two or three (oligo), and 153 (28.7%) had four or more (multiple) BM. The incidence of multiple BM was highest in small cell lung cancer (52%), followed by lung adenocarcinoma (37%). The median OS of patients with multiple BM was 6.7 mons. Regarding the extent of resection (no. of residual BM after primary surgery) on OS: patients with 0 or 1 residual BM had a significantly longer (11.1 mons.) OS compared to those with 2 or 3 residual BM (7.9 mons., p<0.05) or >3 residual BM (5.1 mons., p<0.001). In parallel, PFS also depended on the total amount of residual intracranial lesions after primary surgery (0 or 1 BM left: 6.6 mons. vs. 4.6 mons. (2 or 3 BM left (p<0.05)) vs. 4.6 mons. (>3 BM left (p<0.01)). Multivariate analysis revealed an Odds ratio (OR) >1 for extent of resection and PFS (no. of residual BM 0 or 1 vs. 2 or 3: OR 1.6 (p=0.003); no. of residual BM 0 or 1 vs. >3: OR 1.5 (p=0.01). 32.7% of patients with multiple BM underwent a second surgery for recurrence. Although this group demonstrated a slightly better OS compared to those who did not receive repeated surgery (7.7 vs. 6.2 mons.), the difference was not statistically significant (p=0.95). Notably, the long-term survival rate (OS >24 mons. post-first resection) in patients who underwent repeated resections for multiple BM was only 6%. However, this rate showed variability depending on the primary cancer type, extending to an average of 85.4 mons. in patients with lung adenocarcinoma.
The number of multiple BM varies across different cancer types, but it does not necessarily indicate a poor prognosis. The impact of a more extensive resection (no. of residual BM) on both OS and PFS in cases of resected multiple BM following adjuvant therapy warrants attention.