Postoperative treatment and prognosis of patients with resected single brain metastasis: How useful are established prognostic scores?

Nieder, Carsten; Astner, Sabrina T.; Andratschke, N.; Marienhagen, Kirsten

doi:10.1016/j.clineuro.2010.09.009

Cited by 14 publications

(7 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…1,6,10 A simple and reliable marker that reflects the systemic conditions of patients with brain metastases is needed in the decision-making process for resection. 21,23,26,31 Interest in the host inflammatory response to neoplasms is increasing. Inflammatory cells accumulating around cancer cells play an important role in the prognosis of patients.…”

mentioning

confidence: 99%

Elevated preoperative neutrophil-to-lymphocyte ratio as a predictor of worse survival after resection in patients with brain metastasis

Mitsuya¹,

Nakasu²,

Kurakane

et al. 2017

Journal of Neurosurgery

View full text Add to dashboard Cite

B rain metastases occur in 10% to 40% of patients with cancer and are the most common central nervous system neoplasm in adults. 28,33 With increased surveillance, improved control of systemic cancer, and prolonged survival, the incidence of patients with brain metastases is increasing. 17 The management of brain metastases has been revolutionized in clinical oncology by 4 developments: improved brain imaging, improved management of systemic diseases, the distribution of stereotactic irradiation, and the extension of less invasive surgical techniques that enable brain metastases to be removed even from eloquent brain areas with minimal morbidity. 5Although stereotactic irradiation and pharmacotherapies contribute to the treatment outcome of patients with brain metastasis, resection is still a mainstay for large brain metastases.The indications for resection include a symptomatic mass, a mass with considerable edema requiring high-dose ABBREVIATIONS DS-GPA = diagnosis-specific graded prognostic assessment; KPS = Karnofsky Performance Status; NLR = neutrophil-to-lymphocyte ratio; OS = overall survival; RPA = recursive partitioning analysis. SUBMITTED OBJECTIVEThe median postoperative survival duration of patients with brain metastases who undergo tumor resection is 12 months. Most of these patients die of systemic metastases or the progression of primary cancer but not brain metastases. The criteria for indicating resection are still controversial. Systemic assessment is restricted, especially in patients who need emergent management for their large-size or life-threatening brain metastases. The neutrophil-tolymphocyte ratio (NLR) is reported to correlate with survival time or progression-free survival in patients with various cancers. However, NLR has not been assessed in patients with brain metastases. The impact of NLR on the survival data of patients who had undergone resection of brain metastases was retrospectively analyzed. METHODS The clinical records of patients who underwent resection of brain metastases at Shizuoka Cancer Center between May 2007 and January 2015 were retrospectively analyzed. NLR was calculated by using the data obtained from the latest examination before resection and before the administration of steroid therapy. Kaplan-Meier curves were used for the assessment of overall survival (OS). RESULTS Of the 105 patients included, 67 patients were male. The median age of the patients was 63 years (range 36-90 years). The primary cancers were lung, colon, breast, uterus, and other cancers in 48, 19, 10, 8, and 20 patients, respectively. The postresection median survival duration was 12 months (range 1-91 months) for the entire series. The optimum NLR threshold value was identified as 5. A significant difference in the median OS was found: 14 months for 82 patients with an NLR < 5 versus 5 months for 23 patients with an NLR ≥ 5 (p = 0.001). CONCLUSIONS In this study, an elevated preoperative NLR is a predictor of worse survival after resection for brain metastases. NLR is a simple, systemic m...

show abstract

mentioning

confidence: 99%

Elevated preoperative neutrophil-to-lymphocyte ratio as a predictor of worse survival after resection in patients with brain metastasis

Mitsuya¹,

Nakasu²,

Kurakane

et al. 2017

Journal of Neurosurgery

View full text Add to dashboard Cite

show abstract

“…This improvement in KPS strengthens data available from other smaller series [7,20,21] and plays an important meaning from an oncological point of view since it has a great impact on the response to adjuvant therapies and the overall survival [10,18].…”

Section: Patient Populationmentioning

confidence: 51%

“…In all cases, surgical treatment was the result of a multidisciplinary evaluation; clinical criteria for surgical treatment were as follows: Karnofsky Performance Status (KPS) ≥70, a controlled systemic disease, and the absence of extra-cranial dissemination [10]. Finally, only patients affected by metastasis located within or straight adjacent to the precentral gyrus and to the cortico-spinal tract (≤10 mm) were enrolled in the study.…”

Section: Enrollment Criteriamentioning

confidence: 99%

“…In particular, the consequence of surgery on the functional status (Karnofsky Performance Status, KPS) of these patients has not been investigated so far. Actually, motor outcome can represent a main disability, but functional status in oncological patients is not only a pivotal element of quality of life; it predicts the response to adjuvant therapies and the overall survival of these patients [10,18].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Surgery on motor area metastasis

et al. 2015

View full text Add to dashboard Cite

The role of surgery on central area metastasis remains unclear, and outcome data are still controversial. The aim of our study is to analyze the predictive value of clinical and surgical data on motor and functional outcome of patients, taking into account new emerging data on boundary irregularity of brain metastasis. We retrospectively analyzed 47 consecutive patients who underwent surgery assisted by neurophysiologic monitoring for a solitary metastasis in central area between 2010 and 2013. Inclusion criteria were as follows: good functional status (Karnofsky Performance Status (KPS) ≥70), controlled systemic disease, and absence of extra-cranial dissemination. At 1-month follow up, motor and functional outcomes were compared with preoperative clinical status, response to corticosteroids, extent of tumor resection, boundary irregularity, and size of tumor. Gross total resection was achieved in 93.6% of cases. In preoperative symptomatic patients, motor outcome (according to Medical Research Council grading scale) improved in 55.5% and worsened in 16.7%, while functional outcome (according to KPS score) improved in 50% and worsened in 14.2% of cases. No worsening occurred in preoperative asymptomatic patients. Motor outcome resulted to be not correlated with preoperative deficits, tumor volume, or preoperative response to corticosteroid treatment. Remarkably, motor outcome and extent of surgical resection appeared strongly correlated with tumor boundary irregularity (p < 0.05). Surgery with neurophysiologic monitoring on motor area metastasis can improve functional and motor condition in selected patients. Tumor volume does not represent a limit in surgery. The high correlation between clinical outcome, resection rate, and tumor boundary irregularity strengthens a new belief on the infiltrative growing pattern of brain metastasis. Motor function was evaluated according to Medical Research Council grading scale (Ott et al. 2014) while functional status was assessed according to KPS score.

show abstract

“…compared the five main indices [RPA, SIR, BSBM, Rades (original scoring system based on 4 variables), and GPA] in a retrospective multi-institutional analysis of 74 consecutive patients with a single brain metastasis that was surgically resected over a 15-year interval. [35] Patients accrued in the early phase of the interval received immediate postoperative WBRT, whereas more recently accrued patients were given the choice of immediate WBRT or surveillance after counseling. Eighty percent of patients received WBRT.…”

Section: Prognosismentioning

confidence: 99%

Epidemiology and prognosis of brain metastases

Stelzer¹

2013

Surg Neurol Int

167

112

View full text Add to dashboard Cite

A substantial, but uncertain, number of patients with cancer develop brain metastases. Risk of brain metastasis is recognized to vary with type of primary cancer. Within specific types of primary cancer, prognostic factors for development of brain metastases are being recognized. Recent data suggest that molecular biomarkers that relate to cellular function can predict risk of developing brain metastases. Such information could optimize surveillance standards and/or be used to select patients for preventive interventions. Though average survival for patients with brain metastases is typically less than 6 months, it is well-recognized that subgroups of patients have significant probability of longer survival. Multiple prognostic models have been proposed, validated, and compared without clearly demonstrating superiority of one model over another. However, some factors show consistency as predictive variables across models, and performance status is almost universally significant. Application of predictive models to specific treatments has been difficult. Tumor-specific prognostic models are evolving, and combinations of biological and clinical factors may be used to optimize models for particular primary tumor types.

show abstract

Postoperative treatment and prognosis of patients with resected single brain metastasis: How useful are established prognostic scores?

Cited by 14 publications

References 23 publications

Elevated preoperative neutrophil-to-lymphocyte ratio as a predictor of worse survival after resection in patients with brain metastasis

Elevated preoperative neutrophil-to-lymphocyte ratio as a predictor of worse survival after resection in patients with brain metastasis

Surgery on motor area metastasis

Epidemiology and prognosis of brain metastases

Contact Info

Product

Resources

About