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Survival and prognostic factors in surgically treated brain metastases

  • Vasileios K. KavouridisEmail author
  • Maya Harary
  • Alexander F. C. Hulsbergen
  • Yu T. Lo
  • David A. Reardon
  • Ayal A. Aizer
  • J. Bryan Iorgulescu
  • Timothy R. Smith
Clinical Study

Abstract

Purpose

While surgery and radiation remain the mainstays of therapy for all patients with brain metastases (BM), the management is moving to a more individualized approach based on the underlying tumor. We sought to identify prognostic factors of both intracranial progression (IC-PFS) and overall survival (OS) in a surgical cohort.

Methods

We retrospectively reviewed the records of 1015 patients treated surgically for BM at Brigham and Women’s Hospital (2007–2017). Kaplan–Meier curves were used for OS and IC-PFS and Cox proportional hazards models were built to assess for predictive factors.

Results

Common origins were lung (43.9%), breast (14.4%), and melanoma (13.8%). Median OS for the cohort was 15.4 months (95% confidence interval [95%CI] 14.1–17.1). Breast cancer (22.1 months, 95%CI 17.8–30.3) and colorectal cancer (10.6 months, 95%CI 7.2–15.4) had the longest and shortest OS, respectively. On multivariable Cox regression, significant prognostic factors of shorter OS were age (HR 1.01, 95%CI 1.01–1.02), number of lesions (HR 1.56, 95%CI 1.28–1.89), extracranial spread at BM diagnosis (HR 1.26, 95%CI 1.05–1.52), and KPS (HR 0.98, 95%CI 0.98–0.99). Regarding molecular factors, all driver mutations in lung adenocarcinoma had a favorable effect (EGFR, HR 0.53, 95%CI 0.31–0.89; ALK, HR 0.28, 95%CI 0.12–0.66; KRAS, HR 0.65, 95%CI 0.47–0.92), triple negative status predicted poor prognosis in breast adenocarcinoma (HR 2.04, 95%CI 1.13–3.69), while no effect of BRAF/NRAS mutations was demonstrated in melanoma BMs.

Conclusions

Our results corroborate the role of tumor origin and systemic as well as intracranial spread in OS. Heterogeneity within histologies was further explained by molecular alterations.

Keywords

Brain metastases Surgery Prognostic factors Treatment outcome 

Notes

Funding

This research received no specific grant from any public, commercial or not-for-profit agency.

Compliance with ethical standards

Conflict of interest

VK. Kavouridis, M. Harary, A.F.C Hulsbergen, D.A. Reardon, A.A. Aizer, T.R. Smith declares that they have no conflict of interest. J.B. Iorgulescu is supported by an NIH 5T32HL007627-34 award.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Vasileios K. Kavouridis
    • 1
    • 2
    Email author
  • Maya Harary
    • 1
    • 2
  • Alexander F. C. Hulsbergen
    • 1
    • 2
  • Yu T. Lo
    • 1
    • 2
  • David A. Reardon
    • 2
    • 3
  • Ayal A. Aizer
    • 2
    • 4
  • J. Bryan Iorgulescu
    • 1
    • 2
    • 3
    • 4
    • 5
  • Timothy R. Smith
    • 1
    • 2
  1. 1.Department of Neurosurgery, Computational Neuroscience Outcomes CenterBrigham and Women’s HospitalBostonUSA
  2. 2.Harvard Medical SchoolBostonUSA
  3. 3.Department of Medical OncologyDana-Farber Cancer InstituteBostonUSA
  4. 4.Department of Radiation OncologyBrigham and Women’s Hospital, Dana-Farber Cancer InstituteBostonUSA
  5. 5.Department of PathologyBrigham and Women’s HospitalBostonUSA

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