1Department of Neurosurgery, Gui de Chauliac University Hospital, Montpellier, France.
2Desbrest Institute of Epidemiology and Public Health, INSERM, Montpellier, France.
J Neurosurg. 2024 Jan 19;141(1):89-99. doi: 10.3171/2023.11.JNS231923. Print 2024 Jul 1.
Systemic therapeutic advancements have improved the prognosis of cancer patients, leading to surgery more frequently being carried out for patients with multiple brain metastases (BM). The underlying evidence for the strategy is currently lacking. This study aimed to evaluate the prognostic significance of the number of BM and total tumor burden (TTB) on the overall survival (OS) of patients with resected BM of non-small cell lung cancer (NSCLC) in a modern series.
In this monocentric retrospective series, patients who underwent resection of BM of NSCLC between 2015 and 2021 were included. Demographic, clinical, and histological parameters were collected, and formal radiological volumetric analyses were performed. Prognostic biomarkers for cerebral progression-free survival (C-PFS) and OS were analyzed with univariate and multivariate Cox proportional hazards analysis.
One hundred eighty-four patients were included in the study. Among these, 108 patients (58.7%) presented with a single brain metastasis, 36 patients (19.6%) with 2 BM, 22 patients (11.9%) with 3 BM, and 18 patients (9.8%) with more than 3 BM (maximum 15 BM). The mean ± SD (range) preoperative tumor burden was 23.1 ± 25.3 (1.1-145.3) cm3. The mean residual tumor burden after surgery was 0.3 ± 0.8 (0.0-6.3) cm3. By the time of the analysis, 128 patients (69.6%) had died. The median follow-up duration was 49.0 months (95% CI 39.6-63.6). The median OS was 19.2 months (95% CI 13.2-24.0), and the survival rates at 6 months, 1 year, and 2 years were 76% (95% CI 69%-82%), 61% (95% CI 53%-67%), and 43% (95% CI 35%-50%), respectively. The median C-PFS was 8.4 months (95% CI 7.2-12.0). In the Cox multivariate regression model, younger age (< 65 years), single brain metastasis, adjuvant brain radiation therapy, adjuvant use of targeted therapy, and TTB < 7 cm3 were all independent predictors of longer OS.
In this era of modern systemic treatments for cancer, the number of BM and total cerebral tumor burden remain significant prognostic factors of OS. However, resection should be considered as an option even in those patients with multiple BM in order to enhance patient clinical status, enable further local and systemic treatment delivery, and improve their survival and quality of life.
系统治疗的进步改善了癌症患者的预后，导致更多的多发性脑转移（BM）患者接受手术治疗。目前缺乏支持这一策略的基础证据。本研究旨在评估在非小细胞肺癌（NSCLC）脑转移瘤切除的现代系列中，脑转移瘤数量和总肿瘤负担（TTB）对患者总生存期（OS）的预后意义。
在这项单中心回顾性系列研究中，纳入了 2015 年至 2021 年间接受 NSCLC 脑转移瘤切除术的患者。收集了人口统计学、临床和组织学参数，并进行了正式的放射学容积分析。采用单因素和多因素 Cox 比例风险分析评估脑无进展生存期（C-PFS）和 OS 的预后标志物。
本研究共纳入 184 例患者。其中，108 例（58.7%）患者为单发脑转移，36 例（19.6%）为 2 个脑转移，22 例（11.9%）为 3 个脑转移，18 例（9.8%）为 3 个以上脑转移（最多 15 个脑转移）。术前肿瘤负荷的平均值±标准差（范围）为 23.1±25.3（1.1-145.3）cm3。术后残余肿瘤负荷平均值为 0.3±0.8（0.0-6.3）cm3。截至分析时，128 例患者（69.6%）死亡。中位随访时间为 49.0 个月（95%CI 39.6-63.6）。中位 OS 为 19.2 个月（95%CI 13.2-24.0），6 个月、1 年和 2 年的生存率分别为 76%（95%CI 69%-82%）、61%（95%CI 53%-67%）和 43%（95%CI 35%-50%）。中位 C-PFS 为 8.4 个月（95%CI 7.2-12.0）。在 Cox 多因素回归模型中，年龄<65 岁、单发脑转移、术后脑放疗、辅助靶向治疗和 TTB<7cm3 是 OS 延长的独立预测因素。
在癌症的现代全身治疗时代，脑转移瘤的数量和总脑肿瘤负担仍然是 OS 的重要预后因素。然而，即使在多发性脑转移瘤患者中，也应考虑手术切除，以改善患者的临床状况，为进一步的局部和全身治疗提供可能，并提高患者的生存和生活质量。
