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Survival in patients undergoing surgical resection for brain metastasis from lung cancer and utility of different prognostic scales

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Abstract

Brain metastases (BM) from lung cancer are among the most common intracranial tumors. Several studies have published scales to estimate the survival of patients with BM. Routine access to molecular diagnostics and modern oncologic treatments, including targeted therapy and immunotherapy, is limited in low- and middle-income countries (LMICs); therefore, incorporating them into recent prognostic scales may diminish the reliability of the scales in LMICs. This retrospective study aimed to determine the survival of 55 patients who were surgically treated for BM from lung cancer at a Brazilian public tertiary teaching hospital between 2012 and 2022. We determined clinical factors associated with survival, and compared observed survival rates with the estimated survival on prognostic scales. The mean overall survival (OS) was 9.3 months (range:0.2–76.5). At univariate analysis, female sex and improved postoperative Karnofsky performance status (KPS) score were associated with longer survival. The median survival did not differ between groups when classified using the Graded Prognostic Assessment (GPA)-2008, Lung-molecular GPA-2017, and Lung-GPA-2021 scales. According to the Diagnosis-Specific (DS)-GPA-2012 scale, there was a significant difference between the groups. In the multivariate Cox regression survival analysis, a higher DS-GPA-2012 and improved postoperative KPS score remained significantly associated with longer survival. In conclusion, this cohort showed a mean OS of < 1 year. Improved KPS score after surgery was associated with increased survival. This cohort DS-GPA scale demonstrated the highest concordance with observed survival, indicating its potential as a valuable tool for patient stratification in surgical treatment decision-making in LMICs.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon request.

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Funding

This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brasil (CAPES)—Finance Code 001.

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Authors and Affiliations

  1. Department of Neurology, Psychology and Psychiatry, UNESP – São Paulo State University. Botucatu Medical School, Botucatu, Brazil

    Fábio Pires Botta, Adriano Yacubian Fernandes, Marco Antônio Zanini & Pedro Tadao Hamamoto Filho

  2. Clinics Hospital of Botucatu Medical School, Botucatu, Brazil

    Lilian Aline Rocha

  3. Department of Surgery and Orthopedics, UNESP – São Paulo State University. Botucatu Medical School, Botucatu, Brazil

    Vanessa das Graças Pereira de Souza & Patrícia Pintor dos Reis

  4. Department of Internal Medicine, UNESP – São Paulo State University, Botucatu Medical School, Botucatu, Brazil

    Estela de Oliveira Lima & Adriana Camargo Ferrasi

Authors
  1. Fábio Pires Botta
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  2. Lilian Aline Rocha
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  3. Vanessa das Graças Pereira de Souza
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  4. Patrícia Pintor dos Reis
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  5. Estela de Oliveira Lima
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  6. Adriana Camargo Ferrasi
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  7. Adriano Yacubian Fernandes
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  8. Marco Antônio Zanini
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  9. Pedro Tadao Hamamoto Filho
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Contributions

Conceptualization: PTHF, PPR. Data curation: FBP, LAR, VGPS. Formal analysis: PTHF. Investigation: FPB, LAR, VGPS, PPR. Project administration: PPR, MAZ, PTHF. Visualization: EOL, ACF, AYF, MAZ. Manuscript draft: FPB. Review and editing: VGPS, PPR, EOL, ACF, AYF, MAZ. Approval of final version: all.

Corresponding author

Correspondence to Pedro Tadao Hamamoto Filho.

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Ethics approval

The study protocol was approved by the local institutional review board (IRB 4.459.416/2020), and conducted in accordance with the Declaration of Helsinki.

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Informed consent was obtained from the patients or their relatives, if the patients had died.

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The authors declare no competing interests.

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Botta, F.P., Rocha, L.A., de Souza, V.d.G.P. et al. Survival in patients undergoing surgical resection for brain metastasis from lung cancer and utility of different prognostic scales. Neurosurg Rev 46, 184 (2023). https://doi.org/10.1007/s10143-023-02092-3

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  • DOI: https://doi.org/10.1007/s10143-023-02092-3

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