Background: The impact of surgical resection on the survival and functional outcomes of patients with multiple brain metastases remains a critical question in neuro-oncology. Methods: This retrospective study involved 160 patients who underwent surgical resection of brain metastases from 2017 to 2020. Patients were classified by the number of metastases—single, oligometastatic, or multiple—and whether complete removal of the main symptomatic lesion was achieved. Outcomes such as survival rates, complications, and functional status were assessed. Results: Among the patients, 48.1% had a single metastasis, 21.9% were oligometastatic, and 30% had multiple metastases. Survival did not differ by number of metastases when the main lesion was completely resected and remaining lesions were radiated (p= 0.6172). Complete resection increased mean survival to 15.74 months compared with 4.5 months without it. Additionally, patients who underwent complete resection experienced fewer seizures (16.2% vs. 32.6%,p= 0.019), implying a lower seizure risk. Functional independence was maintained post-surgery. Conclusions: While multiple brain metastases are generally associated with poor outcomes, a trend toward longer survival was observed after complete resection of the index metastasis, though this was not statistically significant. Radiation of residual lesions remains important to support prognosis. Reducing the tumor volume is key to lowering seizure risk. This study supports the role of aggressive surgical interventions, paired with radiation, to potentially enhance outcomes in patients with multiple brain metastases.
背景：手术切除对多发性脑转移瘤患者生存及功能预后的影响，仍是神经肿瘤学领域的关键问题。 方法：本研究回顾性纳入2017年至2020年间接受脑转移瘤手术切除的160例患者。根据转移灶数量（单发、寡转移、多发）及主要症状性病灶是否完全切除进行分组，评估生存率、并发症及功能状态等结局指标。 结果：患者中48.1%为单发转移，21.9%为寡转移，30%为多发转移。当主要病灶完全切除且残余病灶接受放疗时，不同转移灶数量组间的生存率无显著差异（p=0.6172）。完全切除组平均生存期达15.74个月，未完全切除组仅为4.5个月。此外，完全切除组患者术后癫痫发生率更低（16.2% vs. 32.6%，p=0.019），提示癫痫风险降低。患者术后功能独立性得以维持。 结论：尽管多发性脑转移通常预后不良，但在完全切除主要转移灶后观察到生存期延长的趋势（虽无统计学显著性）。残余病灶的放疗对改善预后仍至关重要。降低肿瘤体积是减少癫痫风险的关键。本研究支持积极手术干预联合放疗的治疗策略，可能改善多发性脑转移患者的临床结局。
Evaluating the Impact of Index Metastasis Resection in Patients with Multiple Brain Metastases
肿瘤(癌症)患者之家