Identifying Better Surgical Candidates Among Recursive Partitioning Analysis Class 2 Patients who Underwent Surgery for Intracranial Metastases

Abstract

OBJECTIVE The management of patients with brain metastases is typically dependent on their prognosis. Recursive partitioning analysis (RPA) is the most commonly used method for prognosticating survival, but has limitations for patients in the intermediate class. The aims of this study were to ascertain preoperative risk factors associated with survival, develop a preoperative prognostic grading system, and evaluate the utility of this system in predicting survival for RPA class 2 patients. METHODS Adult patient who underwent intracranial metastatic tumor surgery at an academic tertiary care institution from 1997 to 2011 were retrospectively reviewed. Multivariate proportional hazards regression analysis was used to identify preoperative factors associated with survival. The identified associations were then used to develop a grading system. Survival as a function of time was plotted using the Kaplan-Meier method, and survival rates were compared using log-rank analyses. RESULTS A total of 421 (59%) of 708 patients were RPA class 2. The preoperative factors found to be associated with poorer survival were: male gender (P < 0.0001), motor deficit (P = 0.0007), cognitive deficit (P = 0.0004), nonsolitary metastases (P = 0.002), and tumor size >2 cm (P = 0.003). Patients having 0–1, 2, and 3–5 of these variables were assigned a preoperative grade of A, B, and C, respectively. Patients with a preoperative grade of A, B, and C had a median survival of 17.0, 10.3, and 7.3 months, respectively. These grades had distinct survival times (P < 0.05). CONCLUSIONS The present study devised a preoperative grading system that may provide prognostic information for RPA class 2 patients, which may also guide medical and surgical therapies before any intervention is pursued.

Surgical Management of Deep-Seated Metastatic Brain Tumors Using Minimally Invasive Approaches

“…[1][2][3][4][5] Approximately 30 to 70% of patients with primary cancers develop metastatic brain tumors. [1][2][3][4][5] This number is expected to rise as more patients develop primary cancers, imaging technology becomes more widely available, and the lack of progress continues in finding ways to prevent cancers from metastasizing to the brain. [1][2][3][4][5] When patients develop metastatic brain tumors, the treatment typically involves some combination of surgery and/or radiation therapy.…”

“…[1][2][3][4][5] This management is partially dictated by their RPA class, consisting of age, KPS, primary tumor control, and the presence of systemic disease. [1][2][3][4][5] Patients in RPA class I (age < 65 years, KPS ! 70, controlled primary cancer, and no extracranial metastases) and many in class II (age > 65 years, KPS !…”

“…[1][2][3][4][5] The treatment of this disease involves some combination of surgery and/or radiation therapy. [1][2][3][4][5] Surgery is typically reserved for patients with good neurologic function, solitary and accessible lesions, symptomatic lesions, and/or those with good systemic control of their primary cancer. 2,3,6,7 A subset of patients with metastatic brain cancer develop deep-seated lesions within critical white matter tracts, basal ganglia, and/or thalamic structures.…”

“…2,3,6,7 A subset of patients with metastatic brain cancer develop deep-seated lesions within critical white matter tracts, basal ganglia, and/or thalamic structures. 2,3,6,7 These lesions are typically treated with stereotactic radiosurgery (SRS) because of the potentially increased risk of surgical morbidity associated with accessing and resecting them. 6,7 SRS, unlike surgery, does not improve mass effect, is less effective for larger lesions, is associated with a delayed treatment effect, and does not provide tissue for diagnosis and molecular analyses.…”

Brain Metastases of Non–Small Cell Lung Cancer: Prognostic Factors in Patients with Surgical Resection

“…13 A tumor size > 2 cm was associated with poorer survival. 31 Some reports analyzed the differences between the fate of those patients with a single brain metastasis and those with more than one brain metastasis. We did not find any significant difference in patient survival regarding the number of metastases, although all patients included in this study had fewer than three metastases.…”