Curative Effect And Prognostic Factors Correlated With Survival Among Patients With Surgically Resected Multiple Brain Metastases

ObjectivesWith the development of imaging technology combined the improvement modality therapy, survival time of tumor patients are significantly longer than before in recent years, resulting the incidence of brain metastases(BMs) of malignant tumors is significantly increased. At the time of diagnosis, most patients have more than one lesion, they ofter have a poorer prognosis and higher mortality rate. Modern medicine therapeutic approaches to BMs include surgery, whole brain radiotherapy(WBRT),stereotactic radiosurgery(SRS), chemotherapy, targeted therapy, immune therapy and symptomatic and supportive treatment. In recent years, with the rapid development of the nervous microsurgical techniques, operation has become one of the primary means of single BM patients, but in the higher incidence of multiple BMs, the role of surgery remains controversial. This study analyzes the clinical data of patients with surgically resected multiple BMs, it aims to explore the curative effect and the relevant prognostic factors to improve the quality of life, survival time and other aspects of the clinical effect, then provide some useful references for clinical work.MethodsWe collected clinical materials of treatment for multiple brain metastatic patients with surgery from January 1 of 2002 to December 1 of 2012 from Tianjin Medical University Cancer Institute and Hospital, and investigated patients through outpatient clinic, telephone and correspondence, the follow-up rate was 100%. We established a database that including all information of the patients, Statistical analyses were performed using the SPSS17.0 software, overall survival curves were estimated using the Kaplane-Meier method, the log-rank test and cox proportional hazard model(Cox regression) were used to evaluate each variable’s ability to predict overall survival after BMs through the univariate and multivariate prognostic analysis respectively, P values <0.05 were regarded as indicating statistically significant differences.Results1 Characteristics of the metastatic lesionsThe proportion of men and women in this group of patients was l:1, the median age was 52 years, median KPS score was 80 points; 61 cases of primary tumors were clear and confirmed by biopsy or operation, including lung cancer(n=32), breast cancer(n=12), digestive tract cancer(n=6), malignant melanoma(n=4), reproductive system tumor(n=3), renal cell carcinoma(n=2) and thyroid carcinoma(n=2), 1 case ofprimary tumors was undefined when diagnosed BMs; 31 cases of the lesions were supratentorial in location, 3 cases were subtentorial in location, and the supratentorial and infratentorial tumors were account for 28cases; 29 cases of the BMs had extracranial metastases and 33 cases had no extracranial metastases; 62 cases of primary tumors were controled; 54 cases had preoperative neurologic symptoms and sign, including headache(n=46), nausea and vomiting(n=19), vision loss(n=6), focal weakness or sensory impairments(n=24), ataxia(n=9), epileptic seizures(n=3), aphasia or agraphiat(n=2), 8 casesa of symptomatic BMs were detected by head CT or MRI examination.2 Postoperative survival and prognosis of BMs2.1 Improvement of neurological symptoms and signsAfter surgery, 50 from 54(92.6%) cases with preoperative neurologic symptoms and signs had disappeared or improved, 4(7.4%)cases no obviously improved, no aggravating or death cases, 8 cases of with no preoperative neurological symptoms and signs revealed no nervous signs and symptoms after the operation.2.2 Survival time and survival rateSurvival rate and survival time calculated from diagnosis of BMs, and median survival was 12 months, with 1-year, 2-year, 3-year survival percentages of 54.8%,17.7%, 4.8% respectively.2.3 Prognostic factors affecting survival analysis2.3.1 Univariate prognostic analysis of BMsUnivariate prognosis analysis showed that the independent prognostic factors for patients with multiple BMs treated by surgery were number of brain metastases(P<0.001), extracranial metastasis status(P=0.012), preoperative radiotherapy(P=0.041), postoperative chemotherapy(P=0.006) and the therapy of BMs(P=0.027).2.3.2 Multivariate prognostic analysis of BMsCox multivariate analysis showed that the number of BMs(P=0.001),extracranial metastasis status(P=0.047), preoperative radiotherapy(P<0.001) and the therapy of brain metastases(P=0.001) were the independent prognostic factors.Comparing each two group of brain metastases tumor therapy, surgery combined with chemoradiotherapy group was significant different in median survival time compared to simple surgical group(15 months vs 9 months, c2=6.569, P=0.010) and the surgery combined with radiotherapy group(15 months vs 12 months, c2=7.158, P=0.007).ConclusionsSurgery can obviously relieve clinical symptoms of patients with multiple BMs and improve their life quality. For the patients with primary tumor control, no extracranial metastasis, the number of intracranial metastases less than three and preoperative brain radiotherapy, surgery is a better choice that can save the part of the patients’ life. Surgery conbined with the comprehensive therapy would probably further prolong their life. The result needs randomized trials to further study and confirm.