Background: Despite advances in treatment for brain metastases (BMs), the prognosis for recurrent BMs remains poor and requires further research to advance clinical management and improve patient outcomes. In particular, data addressing the impact of tumor volume and surgical resection with regard to survival remain scarce. Methods: Adult patients with recurrent BMs between December 2007 and December 2022 were analyzed. A distinction was made between operated and non-operated patients, and the residual tumor burden (RTB) was determined by using (postoperative) MRI. Survival analysis was performed and RTB cutoff values were calculated using maximally selected log-rank statistics. In addition, further analyses on systemic tumor progression and (postoperative) tumor therapy were conducted. Results: In total, 219 patients were included in the analysis. Median age was 60 years (IQR 52–69). Median preoperative tumor burden was 2.4 cm3(IQR 0.8–8.3), and postoperative tumor burden was 0.5 cm3(IQR 0.0–2.9). A total of 95 patients (43.4%) underwent surgery, and complete cytoreduction was achieved in 55 (25.1%) patients. Median overall survival was 6 months (IQR 2–10). Cutoff RTB in all patients was 0.12 cm3, showing a significant difference (p= 0.00029) in overall survival (OS). Multivariate analysis showed preoperative KPSS (HR 0.983, 95% CI, 0.967–0.997,p= 0.015), postoperative tumor burden (HR 1.03, 95% CI 1.008–1.053,p= 0.007), and complete vs. incomplete resection (HR 0.629, 95% CI 0.420–0.941,p= 0.024) as significant. Longer survival was significantly associated with surgery for recurrent BMs (p= 0.00097), and additional analysis demonstrated the significant effect of complete resection on survival (p= 0.0027). In the subgroup of patients with systemic progression, a cutoff RTB of 0.97 cm3(p= 0.00068) was found; patients who had received surgery also showed prolonged OS (p= 0.036). Single systemic therapy (p= 0.048) and the combination of radiotherapy and systemic therapy had a significant influence on survival (p= 0.036). Conclusions: RTB is a strong prognostic factor for survival in patients with recurrent BMs. Operated patients with recurrent BMs showed longer survival independent of systemic progression. Maximal cytoreduction should be targeted to achieve better long-term outcomes.
背景：尽管脑转移瘤（BMs）的治疗已取得进展，但复发性BMs的预后仍然较差，需要进一步研究以推进临床管理并改善患者结局。特别是关于肿瘤体积和手术切除对生存影响的数据仍然匮乏。方法：分析2007年12月至2022年12月期间复发性BMs的成年患者。区分手术与非手术患者，并通过（术后）MRI测定残留肿瘤负荷（RTB）。进行生存分析，并使用最大选择对数秩统计计算RTB截断值。此外，还对全身肿瘤进展及（术后）肿瘤治疗进行了进一步分析。结果：共纳入219例患者进行分析。中位年龄为60岁（IQR 52-69）。术前中位肿瘤负荷为2.4 cm³（IQR 0.8-8.3），术后中位肿瘤负荷为0.5 cm³（IQR 0.0-2.9）。共95例患者（43.4%）接受了手术，其中55例（25.1%）实现了完全减瘤。中位总生存期为6个月（IQR 2-10）。所有患者的RTB截断值为0.12 cm³，显示总生存期（OS）存在显著差异（p=0.00029）。多变量分析显示术前KPSS（HR 0.983，95% CI 0.967-0.997，p=0.015）、术后肿瘤负荷（HR 1.03，95% CI 1.008-1.053，p=0.007）以及完全切除与不完全切除（HR 0.629，95% CI 0.420-0.941，p=0.024）具有显著意义。较长生存期与复发性BMs手术显著相关（p=0.00097），进一步分析显示完全切除对生存有显著影响（p=0.0027）。在全身进展患者亚组中，RTB截断值为0.97 cm³（p=0.00068）；接受手术的患者也表现出OS延长（p=0.036）。单一全身治疗（p=0.048）以及放疗联合全身治疗对生存有显著影响（p=0.036）。结论：RTB是复发性BMs患者生存的重要预后因素。接受手术的复发性BMs患者无论全身是否进展均表现出更长的生存期。应以最大程度减瘤为目标，以获得更好的长期结局。
肿瘤(癌症)患者之家