1330 The Impact of Systemic Disease Status on Postoperative Outcomes After Resection of Brain Metastases: A Single Center Study

INTRODUCTION: The prognosis of patients with brain metastasis (BM) depends on patient and disease-specific factors. Although systemic disease status is a known BM prognostic factor, the extent of this association with postoperative outcomes has not been clearly elucidated. METHODS: A single center, retrospective study was conducted including patients who underwent BM resection over a 20-year period. Patients were stratified based on systemic disease status (stable/active vs no evidence of disease). Outcomes included survival, time to CNS progression, and perioperative complications. RESULTS: The cohort consisted of 475 patients of which 267 had stable/active extracranial systemic disease present while 208 had no evidence of disease. Patients with stable/active disease were more likely to have diagnosis of NSCLC, worse preoperative KPS, and prior treatment with targeted therapy and radiation therapy. Patients with stable/active systemic disease exhibited shorter survival (KM Analysis: Median 12.27 vs 25.37 months, Log-rank p<0.000; Multivariate Cox Proportional Hazard Model: HR 1.76, p=0.0001). Further analysis by cancer type showed that stable/active systemic disease impacted survival with a greater degree in patients with NSCLC and more uncommon cancers (Median 11.8 vs. 33.97 months, Log-rank p<0.001; Median 6.6 vs. 65.97 months, Log-rank p<0.006). Patients with stable/active systemic disease experienced shorter freedom from distant CNS progression (KM Analysis: Median 12.2 vs 33.6 months, Log-rank p<0.0004; Multivariable Cox Proportional Hazard Model: HR 1.73, p=0.0002). There were no differences between postoperative complications by 30 days, readmission rates, or local progression. CONCLUSIONS: Systemic disease status impacts postoperative outcomes in patients undergoing resection of a BM and should be considered in the surgical treatment decision-making process.