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

Öz

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.

Anahtar Kelimeler

• Brain metastases
• karnofsky performance status
• prognostic factors
• survival analysis
• neurosurgery

Etik Beyan

Approval for the study was obtained from the Ethics Committee of Ankara Bilkent City Hospıtal on 25.02.2026 (No. TABED 1-26-2245).

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

Öz

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.

Anahtar Kelimeler

• Beyin metastazları
• karnofsky performans durumu
• prognostik faktörler
• sağkalım analizi
• nöroşirürji

Etik Beyan

Çalışma için Ankara Bilkent Şehir Hastanesi Etik Kurulu'ndan 25.02.2026 tarihinde (No. TABED 1-26-2245) onay alınmıştır.

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