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Journals / Batı Karadeniz Tıp Dergisi / 2026 / Cilt: 10 Sayı: 2

Postoperative functional status as the primary determinant of survival in surgically treated brain metastases: A retrospective cohort analysis

Cerrahi olarak tedavi edilen beyin metastazlarında sağkalımın birincil belirleyicisi olarak ameliyat sonrası fonksiyonel durum: Retrospektif kohort analizi

Mehmet Özgür Özateş(Yıldırım Beyazıt University, Faculty of Medicine, Department of Neurosurgery, Ankara, Türkiye)0000-0002-2051-7766
Kadir Çetinkaya(Hitit University, Corum Erol Olcok Training and Research Hospital, Department of Neurosurgery, Corum, Türkiye)0000-0003-2486-4631
Yaşar Ünsal(Bilkent City Hospital, Department of Neurosurgery, Ankara, Türkiye)0009-0006-8655-4718
Murat Kaplan(Bilkent City Hospital, Department of Neurosurgery, Ankara, Türkiye)0009-0007-8325-2164
Tuğrul Şensoy(Hitit University, Corum Erol Olcok Training and Research Hospital, Department of Neurosurgery, Corum, Türkiye)0009-0003-3225-5964
Erva Eser(Kırıkkale University, Faculty of Veterinary Medicine, Department of Biostatistics, Kırıkkale, Türkiye)0000-0002-9827-6288
Pages
300–310
Publication Date
2026-08-31
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

The objective of the current investigation was to evaluate the clinical and surgical determinants that impact overall survival (OS) outcomes in a cohort of patients undergoing resection for BM.

📌 3 Key Takeaways

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Objective & Hypothesis:Aim: Brain metastases (BM) are an increasing oncological challenge due to improved systemic cancer survival.
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Key Findings & Data:Material and Methods: A total of 158 adult cases treated surgically for intracranial metastases from January 2018 to December 2024 were systematically analyzed through a retrospective institutional review.
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Conclusion & Impact:The objective of the current investigation was to evaluate the clinical and surgical determinants that impact overall survival (OS) outcomes in a cohort of patients undergoing resection for BM.
🔬Design:Review & Systematic Survey
📍Scope:2018 Verileri
⚙️Variables:Beyin metastazları · karnofsky performans durumu · prognostik faktörler

Abstract

Aim: Brain metastases (BM) are an increasing oncological challenge due to improved systemic cancer survival. Surgical resection is essential for symptom control and diagnosis; however, survival outcomes remain heterogeneous. The objective of the current investigation was to evaluate the clinical and surgical determinants that impact overall survival (OS) outcomes in a cohort of patients undergoing resection for BM. Material and Methods: A total of 158 adult cases treated surgically for intracranial metastases from January 2018 to December 2024 were systematically analyzed through a retrospective institutional review. Demographic, clinical, radiological, and surgical variables were analyzed. OS was the primary endpoint. The Kaplan-Meier method was utilized for survival estimation, while the influence of various covariates on prognosis was examined through Cox proportional hazards modeling. The Tarone-Ware test was used to assess early survival differences. Results: Our analysis revealed a median survival time of 6.0 months. Initial univariable screening showed that survival was significantly linked to factors such as patient age, gender, adjuvant therapies, and KPS measured at different perioperative stages. In the revised multivariable analysis, postoperative KPS (HR: 0.974, 95% CI: 0.962-0.986, p<0.001), female sex (HR: 0.421, 95% CI: 0.263-0.675, p<0.001), and chemotherapy (HR: 0.531, 95% CI: 0.307-0.917, p=0.023) remained independently associated with OS. In an additional sensitivity analysis, perioperative KPS change was also significantly associated with survival. Conclusion: Postoperative functional status (KPS ≥70), female sex, and adjuvant chemotherapy are independent predictors of improved survival in patients undergoing surgery for BM. These findings emphasize that preservation of neurological function and effective systemic therapy are more critical determinants of outcome than preoperative status alone. Surgical decision-making should therefore adopt a multidisciplinary approach focused on functional preservation and systemic disease control.

Özet

Amaç: Sistemik kanser sağkalımının iyileşmesi nedeniyle beyin metastazları (BM), giderek artan bir onkolojik zorluk teşkil etmektedir. Cerrahi rezeksiyon, semptom kontrolü ve tanı için şarttır; ancak sağkalım sonuçları heterojen kalmaktadır. Bu çalışmanın amacı, beyin metastazı nedeniyle rezeksiyon geçiren bir hasta kohortunda genel sağkalım (OS) sonuçlarını etkileyen klinik ve cerrahi belirleyicileri değerlendirmektir. Gereç ve Yöntemler: Ocak 2018 ile Aralık 2024 tarihleri arasında intrakraniyal metastazlar nedeniyle cerrahi olarak tedavi edilen toplam 158 yetişkin vaka, retrospektif bir kurumsal inceleme yoluyla sistematik olarak analiz edildi. Demografik, klinik, radyolojik ve cerrahi değişkenler analiz edildi. Birincil sonlanım noktası genel sağkalımdı (OS). Sağkalım tahmini için Kaplan-Meier yöntemi kullanılırken, çeşitli kovaryatların prognoz üzerindeki etkisi Cox orantılı tehlike modellemesi ile incelendi. Erken sağkalım farklılıklarını değerlendirmek için Tarone-Ware testi kullanıldı. Bulgular: Analizimiz, ortalama hayatta kalma süresinin 6,0 ay olduğunu ortaya koydu. İlk tek değişkenli tarama, hayatta kalmanın hasta yaşı, cinsiyeti, adjuvan tedaviler ve ameliyat öncesi ve sonrası farklı aşamalarda ölçülen KPS gibi faktörlerle önemli ölçüde ilişkili olduğunu gösterdi. Çok değişkenli analizde postoperatif KPS (HR: 0,974, %95 GA: 0,962-0,986, p<0,001), kadın cinsiyeti (HR: 0,421, %95 GA: 0,263-0,675, p<0,001) ve kemoterapi (HR: 0,531, %95 GA: 0,307-0,917, p=0,023) OS ile bağımsız olarak ilişkili kaldı. Ek duyarlılık analizinde perioperatif KPS değişimi de sağkalımla anlamlı ilişki gösterdi. Sonuç: Ameliyat sonrası fonksiyonel durum (KPS ≥70), kadın cinsiyeti ve adjuvan kemoterapi, beyin metastazı nedeniyle ameliyat geçiren hastalarda sağkalımın iyileşmesinin bağımsız belirleyicileridir. Bu bulgular, nörolojik fonksiyonun korunmasının ve etkili sistemik tedavinin, tek başına ameliyat öncesi durumdan daha kritik sonuç belirleyicileri olduğunu vurgulamaktadır. Bu nedenle cerrahi karar verme sürecinde, fonksiyonel koruma ve sistemik hastalık kontrolüne odaklanan çok disiplinli bir yaklaşım benimsenmelidir.

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Cite This Article

Özateş, M. Ö., Çetinkaya, K., Ünsal, Y., Kaplan, M., Şensoy, T., Eser, E. (2026). Postoperative functional status as the primary determinant of survival in surgically treated brain metastases: A retrospective cohort analysis. Batı Karadeniz Tıp Dergisi, Cilt: 10 Sayı: 2, 300–310. https://doi.org/10.29058/mjwbs.1949238

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References (25)

  1. Aizer AA, Lamba N, Ahluwalia MS, Aldape K, Boire A, Brastianos PK, et al. Brain metastases: A Society for Neuro-Oncology (SNO) consensus review on current management and future directions. Neuro Oncol. 2022;24(10):1613-1646. https://doi.org/10.1093/neuonc/noac118
  2. Suh JH, Kotecha R, Chao ST, Ahluwalia MS, Sahgal A, Chang EL. Current approaches to the management of brain metastases. Nat Rev Clin Oncol. 2020;17(5):279-299. https://doi.org/10.1038/s41571-019-0320-3
  3. Lin X, DeAngelis LM. Treatment of brain metastases. J Clin Oncol. 2015;33(30):3475-3484. https://doi.org/10.1200/JCO.2015.60.9503
  4. Vogelbaum MA, Brown PD, Messersmith H, Brastianos PK, Burri S, Cahill D, et al. Treatment for brain metastases: ASCO-SNO-ASTRO guideline. J Clin Oncol. 2022;40(5):492-516. https://doi.org/10.1200/JCO.21.02314
  5. Soffietti R, Abacioglu U, Baumert B, Combs SE, Kinhult S, Kros JM, et al. Diagnosis and treatment of brain metastases from solid tumors: guidelines from the European Association of Neuro-Oncology (EANO). Neuro Oncol. 2017;19(2):162-174. https://doi.org/10.1093/neuonc/now241
  6. Achrol AS, Rennert RC, Anders C, Soffietti R, Ahluwalia MS, Nayak L, et al. Brain metastases. Nat Rev Dis Primers. 2019;5(1):5. https://doi.org/10.1038/s41572-018-0055-y
  7. Sperduto PW, Mesko S, Li J, Cagney D, Aizer A, Lin NU, et al. Survival in patients with brain metastases: summary report on the updated Diagnosis-Specific Graded Prognostic Assessment and definition of the eligibility quotient. J Clin Oncol. 2020;38(32):3773-3784. https://doi.org/10.1200/JCO.20.01255
  8. Katano A, Yamashita H. Brain metastasis: recent treatment modalities and future perspectives. Oncol Lett. 2022;23(6):191. https://doi.org/10.3892/ol.2022.13311
  9. Braunstein S, Sneed P, Boyle J, Kirkpatrick JP, Mak KS, Shih HA, et al. Estimating survival in patients with lung cancer and brain metastases: an update of the graded prognostic assessment for lung cancer using molecular markers (Lung-molGPA). JAMA Oncol. 2017;3(6):827-831. https://doi.org/10.1001/jamaoncol.2016.3834
  10. Brown PD, Ballman KV, Cerhan JH, Anderson SK, Carrero XW, Whitton AC, et al. Postoperative stereotactic radiosurgery compared with whole brain radiotherapy for resected metastatic brain disease (NCCTG N107C/CEC·3): a multicentre, randomised, controlled, phase 3 trial. Lancet Oncol. 2017;18(8):1049-1060. https://doi.org/10.1016/S1470-2045(17)30441-2
  11. Pojskic M, Bopp MHA, Schymalla M, Nimsky C, Carl B. Retrospective study of 229 surgically treated patients with brain metastases: prognostic factors, outcome and comparison of recursive partitioning analysis and diagnosis-specific graded prognostic assessment. Surg Neurol Int. 2017;8:259. https://doi.org/10.4103/sni.sni_228_17
  12. Lopes S, Vieira I, Abreu M, Pousa I, Ferreira A, Sousa S, et al. Prognostic factors and survival according to tumor subtype in women with breast cancer brain metastases. Curr Probl Cancer. 2022;46(6):100866. https://doi.org/10.1016/j.currproblcancer.2022.100866
  13. Witzel I, Oliveira-Ferrer L, Pantel K, Müller V, Wikman H. Breast cancer brain metastases: biology and new clinical perspectives. Breast Cancer Res. 2016;18(1):8. https://doi.org/10.1186/s13058-015-0665-1
  14. Fidler IJ. The biology of brain metastasis: challenges for therapy. Cancer J. 2015;21(4):284-293. https://doi.org/10.1097/PPO.0000000000000126
  15. Bernhardt D, Adeberg S, Bozorgmehr F, Opfermann N, Hoerner-Rieber J, König L, et al. Outcome and prognostic factors in patients with brain metastases from small-cell lung cancer treated with whole brain radiotherapy. J Neurooncol. 2017;134(1):205-212. https://doi.org/10.1007/s11060-017-2510-0
  16. Proescholdt M, Jünger ST, Schödel P, Schebesch KM, Doenitz C, Pukrop T, et al. Brain metastases in elderly patients-the role of surgery in the context of systemic treatment. Brain Sci. 2021;11(1):123. https://doi.org/10.3390/brainsci11010123
  17. Brown PD, Jaeckle K, Ballman KV, Farace E, Cerhan JH, Anderson SK, et al. Effect of radiosurgery alone vs radiosurgery with whole brain radiation therapy on cognitive function in patients with 1 to 3 brain metastases: a randomized clinical trial. JAMA. 2016;316(4):401-409. https://doi.org/10.1001/jama.2016.9839
  18. Salvati M, Tropeano MP, Maiola V, Lavalle L, Brogna C, Colonnese C, et al. Multiple brain metastases: a surgical series and neurosurgical perspective. Neurol Sci. 2018;39(4):671-677. https://doi.org/10.1007/s10072-017-3220-2
  19. Schackert G, Lindner C, Petschke S, Leimert M, Kirsch M. Retrospective study of 127 surgically treated patients with multiple brain metastases: indication, prognostic factors, and outcome. Acta Neurochir (Wien). 2013;155(3):379-387. https://doi.org/10.1007/s00701-012-1606-8
  20. Kocher M, Soffietti R, Abacioglu U, Villà S, Fauchon F, Baumert BG, et al. Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952-26001 study. J Clin Oncol. 2011;29(2):134-141. https://doi.org/10.1200/JCO.2010.30.1655
  21. Mantovani C, Gastino A, Cerrato M, Badellino S, Ricardi U, Levis M. Modern radiation therapy for the management of brain metastases from non-small cell lung cancer: current approaches and future directions. Front Oncol. 2021;11:772789. https://doi.org/10.3389/fonc.2021.772789
  22. Antoni D, Clavier JB, Pop M, Schumacher C, Lefebvre F, Noël G. Institutional, retrospective analysis of 777 patients with brain metastases: treatment outcomes and diagnosis-specific prognostic factors. Int J Radiat Oncol Biol Phys. 2013;86(4):630-637. https://doi.org/10.1016/j.ijrobp.2013.02.027
  23. Mulvenna P, Nankivell M, Barton R, Faivre-Finn C, Wilson P, McColl E, et al. Dexamethasone and supportive care with or without whole brain radiotherapy in treating patients with non-small cell lung cancer with brain metastases unsuitable for resection or stereotactic radiotherapy (QUARTZ): results from a phase 3, non-inferiority, randomised trial. Lancet. 2016;388(10055):2004-2014. https://doi.org/10.1016/S0140-6736(16)30825-X
  24. Frati A, Pesce A, Palmieri M, Celniku M, Raco A, Salvati M. Surgical treatment of the septuagenarian patients suffering from brain metastases: a large retrospective observational analytic cohort-comparison study. World Neurosurg. 2018;114:e565-e572. https://doi.org/10.1016/j.wneu.2018.03.034
  25. Sîrbu OM, Chirtes AV, Mitrica M, Gorgan RM. Combined use of intraoperative ultrasound and sodium fluorescein in the surgical resection of brain metastases: a preliminary observational study. J Clin Neurosci. 2025;140:111507. https://doi.org/10.1016/j.jocn.2025.111507