Aftahy Amir Kaywan, Barz Melanie, Lange Nicole, Baumgart Lea, Thunstedt Cem, Eller Mario Antonio, Wiestler Benedikt, Bernhardt Denise, Combs Stephanie E, Jost Philipp J, Delbridge Claire, Liesche-Starnecker Friederike, Meyer Bernhard, Gempt Jens
Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.
Department of Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.
Front Oncol. 2022 May 4;12:869764. doi: 10.3389/fonc.2022.869764. eCollection 2022.
Brain metastases were considered to be well-defined lesions, but recent research points to infiltrating behavior. Impact of postoperative residual tumor burden (RTB) and extent of resection are still not defined enough.
Adult patients with surgery of brain metastases between April 2007 and January 2020 were analyzed. Early postoperative MRI (<72 h) was used to segment RTB. Survival analysis was performed and cutoff values for RTB were revealed. Separate (subgroup) analyses regarding postoperative radiotherapy, age, and histopathological entities were performed.
A total of 704 patients were included. Complete cytoreduction was achieved in 487/704 (69.2%) patients, median preoperative tumor burden was 12.4 cm (IQR 5.2-25.8 cm), median RTB was 0.14 cm (IQR 0.0-2.05 cm), and median postoperative tumor volume of the targeted BM was 0.0 cm (IQR 0.0-0.1 cm). Median overall survival was 6 months (IQR 2-18). In multivariate analysis, preoperative KPSS (HR 0.981982, 95% CI, 0.9761-0.9873, < 0.001), age (HR 1.012363; 95% CI, 1.0043-1.0205, = 0.0026), and preoperative (HR 1.004906; 95% CI, 1.0003-1.0095, = 0.00362) and postoperative tumor burden (HR 1.017983; 95% CI; 1.0058-1.0303, = 0.0036) were significant. Maximally selected log rank statistics showed a significant cutoff for RTB of 1.78 cm ( = 0.0022) for all and 0.28 cm ( = 0.0047) for targeted metastasis and cutoff for the age of 67 years ( < 0.001). (Stereotactic) Radiotherapy had a significant impact on survival ( < 0.001).
RTB is a strong predictor for survival. Maximal cytoreduction, as confirmed by postoperative MRI, should be achieved whenever possible, regardless of type of postoperative radiotherapy.
脑转移瘤过去被认为是边界清晰的病变，但最近的研究表明其具有浸润性。术后残余肿瘤负荷（RTB）和切除范围的影响仍未得到充分明确。
对2007年4月至2020年1月间接受脑转移瘤手术的成年患者进行分析。术后早期MRI（<72小时）用于分割RTB。进行生存分析并得出RTB的临界值。对术后放疗、年龄和组织病理学类型进行了单独（亚组）分析。
共纳入704例患者。487/704（69.2%）例患者实现了完全肿瘤细胞减灭，术前肿瘤负荷中位数为12.4 cm（四分位间距5.2 - 25.8 cm），RTB中位数为0.14 cm（四分位间距0.0 - 2.05 cm），目标脑转移瘤术后肿瘤体积中位数为0.0 cm（四分位间距0.0 - 0.1 cm）。总生存中位数为6个月（四分位间距2 - 18）。多因素分析显示，术前日本昏迷量表评分（HR 0.981982，95%置信区间，0.9761 - 0.9873，< 0.001）、年龄（HR 1.012363；95%置信区间，1.0043 - 1.0205，= 0.0026）以及术前（HR 1.004906；95%置信区间，1.0003 - 1.0095，= 0.00362）和术后肿瘤负荷（HR 1.017983；95%置信区间；1.0058 - 1.0303，= 0.0036）具有显著意义。最大选择对数秩统计显示，所有患者RTB的临界值为1.78 cm（= 0.0022），目标转移瘤为0.28 cm（= 0.0047），年龄临界值为67岁（< 0.001）。（立体定向）放疗对生存有显著影响（< 0.001）。
RTB是生存的有力预测指标。无论术后放疗类型如何，应尽可能通过术后MRI确认实现最大程度的肿瘤细胞减灭。
