Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
Division of Clinical Neuro-Oncology, Department of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
Neurosurg Rev. 2023 Mar 30;46(1):80. doi: 10.1007/s10143-023-01986-6.
Surgical resection is a common treatment modality for brain metastasis (BM). Location of the BM might significantly impact patient survival and therefore might be considered in clinical decision making and patient counseling. In the present study, the authors analyzed infra- and supratentorial BM location for a potential prognostic difference. Between 2013 and 2019, 245 patients with solitary BM received BM resection at the authors' neuro-oncological center. In order to produce a covariate balance for commonly-known prognostic variables (tumor entity, age, preoperative Karnofsky Performance Score, and preoperative Charlson Comorbidity Index), a propensity score matching at a ratio of 1:1 between the cohort of patients with infra- and supratentorial BM location was performed using R. Overall survival (OS) rates were assessed for both matched cohorts of patients with BM. Sixty-one of 245 patients (25%) with solitary BM exhibited an infratentorial tumor location; 184 patients (75%) suffered from supratentorial solitary BM. Patients with infratentorial BM revealed a median OS of 11 months (95% confidence interval (CI) 7.4-14.6 months). Compared with this, median OS for the group of 61 individually matched patients with solitary supratentorial solitary BM was 13 months (95% CI 10.9-15.1 months) (p = 0.32). The present study suggests that the prognostic value of infra- and supratentorial BMs does not significantly differ in patients that undergo surgery for solitary BM. These results might encourage physicians to induce surgical therapy of supra- and infratentorial BM in a similar manner.
手术切除是脑转移瘤（BM）的常见治疗方式。BM 的位置可能会显著影响患者的生存，因此在临床决策和患者咨询中可能会被考虑。在本研究中，作者分析了幕上下 BM 的位置，以探讨其潜在的预后差异。2013 年至 2019 年间，作者所在的神经肿瘤中心对 245 例单发 BM 患者进行了 BM 切除术。为了对常见的预后变量（肿瘤实体、年龄、术前卡诺夫斯基表现评分和术前 Charlson 合并症指数）产生协变量平衡，使用 R 对幕上下 BM 位置的患者队列进行了 1:1 的倾向评分匹配。对两组 BM 患者的总生存率（OS）进行了评估。245 例单发 BM 患者中，61 例（25%）为幕下肿瘤位置；184 例（75%）为幕上单发 BM。幕下 BM 患者的中位 OS 为 11 个月（95%置信区间 7.4-14.6 个月）。相比之下，61 例单独匹配的幕上单发 BM 患者的中位 OS 为 13 个月（95%置信区间 10.9-15.1 个月）（p = 0.32）。本研究表明，在接受单发 BM 手术的患者中，幕上下 BM 的预后价值没有显著差异。这些结果可能鼓励医生以类似的方式对幕上和幕下 BM 进行手术治疗。
