Early and Late Prognostic Factors in Patients with Resected Brain Metastases

Background: Brain metastases are the most common malignant intracranial tumors and remain associated with poor survival despite advances in multimodal treatment. This study aimed to evaluate the associations between clinical, radiological, surgical, and perioperative characteristics and outcomes in patients undergoing surgical resection of brain metastases. Materials and Methods: This retrospective single-center cohort study included 378 consecutive adult patients who underwent resection of histopathologically confirmed brain metastases between 2015 and 2023. Overall survival was estimated using the Kaplan–Meier method, and differences between groups were assessed using the log-rank test. Factors associated with overall survival were evaluated using univariable and multivariable Cox proportional hazards regression. Binary logistic regression was used to evaluate factors associated with 30-day mortality. Results: Median overall survival was 11.3 months, the one-year survival rate was 45.5%, and 18 patients (4.8%) died within 30 days after surgery. In the adjusted logistic regression model, preoperative KPS < 80, hydrocephalus, postoperative hematoma, and postoperative pneumonia were associated with higher odds of 30-day mortality. In the multivariable Cox regression analysis, increasing age, preoperative KPS < 80, tumor volume ≥ 9 cm3, hydrocephalus, wound complications, and postoperative KPS deterioration were independently associated with shorter overall survival. Subtotal versus total resection was not significantly associated with overall survival after adjustment. Conclusions: Several preoperative and postoperative characteristics were associated with early mortality and overall survival in this surgically selected cohort. These findings emphasize the importance of careful patient selection, preservation of functional status, optimization of perioperative care, and prevention of postoperative complications.