Department of Neurosurgery, University Hospital, Bonn, Germany.
Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany.
J Neurooncol. 2023 Feb;161(3):539-545. doi: 10.1007/s11060-023-04242-5. Epub 2023 Jan 25.
Patients with brain metastasis (BM) from solid tumors are in an advanced stage of cancer. BM may occur during a known oncological disease (metachronous BM) or be the primary manifestation of previously unknown cancer (synchronous BM). The time of diagnosis might decisively impact patient prognosis and further treatment stratification. In the present study, we analyzed the prognostic impact of synchronous versus (vs.) metachronous BM occurrence following resection of BM.
Between 2013 and 2018, 353 patients had undergone surgical therapy for BM at the authors' neuro-oncological center. Survival stratification calculated from the day of neurosurgical resection was performed for synchronous vs. metachronous BM diagnosis.
Non-small-cell lung carcinoma (NSCLC) was the most common tumor entity of primary site (43%) followed by gastrointestinal cancer (14%) and breast cancer (13%). Synchronous BM occurrence was present in 116 of 353 patients (33%), metachronous BM occurrence was present in 237 of 353 patients (67%). NSCLC was significantly more often diagnosed via resection of the BM (56% synchronous vs. 44% metachronous situation, p = 0.0001). The median overall survival for patients with synchronous BM diagnosis was 12 months (95% confidence interval (CI) 7.5-16.5) compared to 13 months (95% CI 9.6-16.4) for patients with metachronous BM diagnosis (p = 0.97).
The present study indicates that time of BM diagnosis (synchronous vs. metachronous) does not significantly impact patient survival following surgical therapy of BM. These results suggest that the indication for neurosurgical BM resection should be made regardless of a synchronous or a metachronous time of BM occurrence.
患有脑转移瘤（BM）的实体瘤患者处于癌症晚期。BM 可能在已知的肿瘤疾病期间发生（同步 BM），也可能是先前未知的癌症的主要表现（同步 BM）。诊断时间可能会对患者的预后和进一步的治疗分层产生决定性的影响。在本研究中，我们分析了 BM 切除术后同步与（vs）BM 发生对预后的影响。
2013 年至 2018 年间，作者的神经肿瘤中心对 353 例 BM 患者进行了手术治疗。从神经外科切除之日起对同步与 BM 诊断进行生存分层。
非小细胞肺癌（NSCLC）是原发部位最常见的肿瘤实体（43%），其次是胃肠道癌（14%）和乳腺癌（13%）。353 例患者中有 116 例（33%）为同步 BM 发生，237 例（67%）为异时性 BM 发生。通过 BM 切除诊断 NSCLC 的比例明显更高（56%同步 vs. 44%异时性，p = 0.0001）。同步 BM 诊断患者的中位总生存期为 12 个月（95%置信区间 [CI] 7.5-16.5），而异时性 BM 诊断患者为 13 个月（95%CI 9.6-16.4）（p = 0.97）。
本研究表明，BM 诊断时间（同步 vs. 异时性）对 BM 手术后患者的生存无显著影响。这些结果表明，无论 BM 发生的时间是同步性还是异时性，都应考虑进行神经外科 BM 切除术。
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