title: Risk factors for early death after surgery in patients with brain metastases: reevaluation of the indications for and role of surgery.
abstract: Surgical resection remains an important option for the treatment of brain metastases despite recent advancements in radiotherapy and systemic therapy. When selecting surgical candidates, it is important to exclude terminal cases who will receive neither a survival benefit nor an improvement in their quality of life. We reviewed a total of 264 surgical cases of brain metastases and analyzed the clinical characteristics of early death in order to clarify the indication for and the role of surgery. The median survival time (MST) after surgery in all cases was 12.4 months. Early death was defined as death within 6 months, and 23% (62 cases) of this series were succumbed to this. A decrease in postoperative Karnofsky performance status (KPS) (<70) (P = 0.041), lack of systemic therapy after surgery (P < 0.0001), and uncontrolled extracranial malignancies (P = 0.0022) were significantly related to early death in multivariate analysis, while preoperative KPS (<70) and recursive partitioning analysis (RPA) class were related to early death only in univariate analysis (P < 0.05). When analyzing patients with uncontrolled extracranial malignancies and those with a postoperative KPS score of 70 or greater (who were generally candidates for systemic therapy), the MST was significantly longer in the systemic therapy (+) group compared with the systemic therapy (-) group (12.5 vs. 5.6 months; P = 0.0026). Our data indicate that the postoperative RPA class and treatment strategy were associated with early death. Deterioration of patients by surgery should be avoided in the treatment of brain metastases.
authors.affiliation: Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Arita
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Narita
authors.forename: Yasuji
authors.initials: Y
authors.lastname: Miyakita
authors.forename: Makoto
authors.initials: M
authors.lastname: Ohno
authors.forename: Minako
authors.initials: M
authors.lastname: Sumi
authors.forename: Soichiro
authors.initials: S
authors.lastname: Shibui
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D016634:Radiosurgery / Q000009:adverse effects*; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult