Surgical outcomes and prognostic factors in 228 patients with brain metastases: a focus on en bloc resection and multimodal therapy

This study aimed to evaluate the survival outcomes and identify prognostic factors in patients undergoing surgical resection for brain metastases (BMs), with a particular focus on the impact of surgical techniques and multimodal therapy sequences. We conducted a retrospective analysis of 228 consecutive patients who underwent neurosurgical resection for BMs at a single institution (2012–2020). Primary endpoints were median overall survival (mOS) and survival rates, analyzed via Kaplan-Meier methodology. Prognostic factors were assessed using univariate and multivariate Cox proportional hazards models, with subgroup analyses based on primary tumor origin. The cohort’s overall mOS was 14 months, with 1-, 2-, and 3-year survival rates of 60.3%, 35.4%, and 23.2%, respectively. Multivariate analysis identified preoperative Karnofsky Performance Status (KPS) as a powerful independent prognostic factor (Hazard Ratio [HR] = 49.076, 95% Confidence Interval [CI]: 21.483–112.110, P < 0.001). The treatment modality significantly influenced survival: patients receiving postoperative radiotherapy achieved an mOS of 18 months, compared to 13 months for surgery alone. Strikingly, the cohort receiving combined pre- and postoperative radiotherapy (n = 6) demonstrated a superior mOS of 41 months. In lung cancer BMs (n = 109, mOS = 11 months), targeted therapy was associated with a significantly prolonged mOS of 28 months versus 10 months in non-recipients. For breast cancer BMs (n = 26, mOS = 17 months), chemotherapy was an independent favorable prognostic factor (HR = 6.297, P = 0.009). Surgical resection, particularly when integrated into a multimodal strategy, confers significant survival benefits for patients with BMs. The sequence of therapy is critical, with combined perioperative radiotherapy emerging as a highly promising regimen. Preoperative KPS is a paramount prognosticator. These findings advocate for an aggressive, personalized surgical approach embedded within a comprehensive neuro-oncological framework.