Department of Neurosurgery, School of Medicine, Klinikum Rechts der Isar, Technical University Munich, 81675 Munich, Germany.
Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
Medicina (Kaunas). 2024 Sep 6;60(9):1464. doi: 10.3390/medicina60091464.
The impact of surgery for recurrent brain metastases in elderly patients has been the object of debate due to limited information in the literature. We analyzed clinical outcome and survival of elderly patients with recurrent brain metastases in order to assess potentially beneficial role of surgery. In total, 219 patients with recurrent brain metastases between 2007 and 2022 were identified, of which 95 underwent re-resection; 83 patients aged 65 and older were analyzed. A survival analysis was performed, and clinical outcomes were evaluated. The median survival time after surgery for recurrent brain metastases was 6 months (95CI 4-10) in older patients and 8 (95CI 7-9) in younger patients ( = 0.619). Out of all the older patients, 33 who underwent surgical resection showed prolonged survival compared with patients who did not receive surgical resection (median: 14, 95CI 8-19 vs. 4, 95CI 4-7, = 0.011). All patients had preoperative Karnofsky performance scores of >70, which did not deteriorate after surgery (87.02 ± 5.76 vs. 85 ± 6.85; = 0.055). In the univariate analysis, complete cytoreduction was a favorable prognostic factor. The tumor volume, the number of metastases, extracranial disease progression, adjuvant radiation, and systemic therapy did not affect survival in this cohort. Patients aged 65 and older benefit from neurosurgical resections of recurrent brain metastases. Survival did not differ from that in younger patients, which can be explained by a better preoperative functional status. Moreover, independent of the extent of resection, older patients who underwent surgery showed better survival than patients who did not receive surgical treatment. Complete cytoreduction was a favorable prognostic marker.
手术治疗老年复发性脑转移的影响一直是文献中争论的焦点。我们分析了老年复发性脑转移患者的临床结果和生存情况，以评估手术可能带来的益处。
在 2007 年至 2022 年间，共发现 219 例复发性脑转移患者，其中 95 例接受了再次切除术；分析了 83 例年龄在 65 岁及以上的患者。进行了生存分析，并评估了临床结果。
老年患者复发性脑转移手术后的中位生存时间为 6 个月（95%CI 4-10），年轻患者为 8 个月（95%CI 7-9）（ = 0.619）。在所有老年患者中，33 例接受手术切除的患者与未接受手术切除的患者相比，生存时间延长（中位：14，95%CI 8-19 vs. 4，95%CI 4-7， = 0.011）。所有患者术前 Karnofsky 表现评分均>70，术后无恶化（87.02 ± 5.76 vs. 85 ± 6.85； = 0.055）。单因素分析显示，完全肿瘤细胞减灭术是一个有利的预后因素。肿瘤体积、转移灶数量、颅外疾病进展、辅助放疗和全身治疗在本队列中均未影响生存。
年龄在 65 岁及以上的患者受益于神经外科复发性脑转移切除术。与年轻患者相比，他们的生存时间没有差异，这可以用更好的术前功能状态来解释。此外，与切除范围无关，接受手术治疗的老年患者比未接受手术治疗的患者生存时间更长。完全肿瘤细胞减灭术是一个有利的预后标志物。
