Enhancing outcomes: neurosurgical resection in brain metastasis patients with poor Karnofsky performance score - a comprehensive survival analysis
BackgroundA reduced Karnofsky performance score (KPS) often leads to the discontinuation of surgical and adjuvant therapy, owing to a lack of evidence of survival and quality of life benefits. This study aimed to examine the clinical and treatment outcomes of patients with KPS < 70 after neur...
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Frontiers Media S.A.
2024-01-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2023.1343500/full |
| _version_ | 1797360006175129600 |
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| author | Maria Goldberg Michel G. Mondragon-Soto Ghaith Altawalbeh Lea Baumgart Jens Gempt Denise Bernhardt Denise Bernhardt Stephanie E. Combs Stephanie E. Combs Stephanie E. Combs Bernhard Meyer Amir Kaywan Aftahy |
| author_facet | Maria Goldberg Michel G. Mondragon-Soto Ghaith Altawalbeh Lea Baumgart Jens Gempt Denise Bernhardt Denise Bernhardt Stephanie E. Combs Stephanie E. Combs Stephanie E. Combs Bernhard Meyer Amir Kaywan Aftahy |
| author_sort | Maria Goldberg |
| collection | DOAJ |
| description | BackgroundA reduced Karnofsky performance score (KPS) often leads to the discontinuation of surgical and adjuvant therapy, owing to a lack of evidence of survival and quality of life benefits. This study aimed to examine the clinical and treatment outcomes of patients with KPS < 70 after neurosurgical resection and identify prognostic factors associated with better survival.MethodsPatients with a preoperative KPS < 70 who underwent surgical resection for newly diagnosed brain metastases (BM) between 2007 and 2020 were retrospectively analyzed. The KPS, age, sex, tumor localization, cumulative tumor volume, number of lesions, extent of resection, prognostic assessment scores, adjuvant radiotherapy and systemic therapy, and presence of disease progression were analyzed. Univariate and multivariate logistic regression analyses were performed to determine the factors associated with better survival. Survival > 3 months was considered favorable and ≤ 3 months as poor.ResultsA total of 140 patients were identified. Median overall survival was 5.6 months (range 0-58). There was no difference in the preoperative KPS between the groups of > 3 and ≤ 3 months (50; range, 20–60 vs. 50; range, 10–60, p = 0.077). There was a significant improvement in KPS after surgery in patients with a preoperative KPS of 20% (20 vs 40 ± 20, p = 0.048). In the other groups, no significant changes in KPS were observed. Adjuvant radiotherapy was associated with better survival (44 [84.6%] vs. 32 [36.4%]; hazard ratio [HR], 0.0363; confidence interval [CI], 0.197–0.670, p = 0.00199). Adjuvant chemotherapy and immunotherapy resulted in prolonged survival (24 [46.2%] vs. 12 [13.6%]; HR 0.474, CI 0.263–0.854, p = 0.013]. Systemic disease progression was associated with poor survival (36 [50%] vs. 71 [80.7%]; HR 5.975, CI 2.610–13.677, p < 0.001].ConclusionNeurosurgical resection is an appropriate treatment modality for patients with low KPS. Surgery may improve functional status and facilitate further tumor-specific treatment. Combined treatment with adjuvant radiotherapy and systemic therapy was associated with improved survival in this cohort of patients. Systemic tumor progression has been identified as an independent factor for a poor prognosis. There is almost no information regarding surgical and adjuvant treatment in patients with low KPS. Our paper provides novel data on clinical outcome and survival analysis of patients with BM who underwent surgical treatment. |
| first_indexed | 2024-03-08T15:32:08Z |
| format | Article |
| id | doaj.art-e9d9c1ff1e9d4c60a7cf65df22d46368 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-03-08T15:32:08Z |
| publishDate | 2024-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-e9d9c1ff1e9d4c60a7cf65df22d463682024-01-10T04:30:20ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2024-01-011310.3389/fonc.2023.13435001343500Enhancing outcomes: neurosurgical resection in brain metastasis patients with poor Karnofsky performance score - a comprehensive survival analysisMaria Goldberg0Michel G. Mondragon-Soto1Ghaith Altawalbeh2Lea Baumgart3Jens Gempt4Denise Bernhardt5Denise Bernhardt6Stephanie E. Combs7Stephanie E. Combs8Stephanie E. Combs9Bernhard Meyer10Amir Kaywan Aftahy11Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, GermanyDepartment of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico City, MexicoDepartment of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, GermanyDepartment of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDepartment of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDepartment of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, GermanyGerman Cancer Consortium (DKTK), Partner Site Munich, Munich, GermanyDepartment of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, GermanyGerman Cancer Consortium (DKTK), Partner Site Munich, Munich, GermanyDepartment of Radiation Sciences (DRS), Helmholtz Zentrum Munich, Institute of Innovative Radiotherapy (iRT), Munich, GermanyDepartment of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, GermanyDepartment of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, GermanyBackgroundA reduced Karnofsky performance score (KPS) often leads to the discontinuation of surgical and adjuvant therapy, owing to a lack of evidence of survival and quality of life benefits. This study aimed to examine the clinical and treatment outcomes of patients with KPS < 70 after neurosurgical resection and identify prognostic factors associated with better survival.MethodsPatients with a preoperative KPS < 70 who underwent surgical resection for newly diagnosed brain metastases (BM) between 2007 and 2020 were retrospectively analyzed. The KPS, age, sex, tumor localization, cumulative tumor volume, number of lesions, extent of resection, prognostic assessment scores, adjuvant radiotherapy and systemic therapy, and presence of disease progression were analyzed. Univariate and multivariate logistic regression analyses were performed to determine the factors associated with better survival. Survival > 3 months was considered favorable and ≤ 3 months as poor.ResultsA total of 140 patients were identified. Median overall survival was 5.6 months (range 0-58). There was no difference in the preoperative KPS between the groups of > 3 and ≤ 3 months (50; range, 20–60 vs. 50; range, 10–60, p = 0.077). There was a significant improvement in KPS after surgery in patients with a preoperative KPS of 20% (20 vs 40 ± 20, p = 0.048). In the other groups, no significant changes in KPS were observed. Adjuvant radiotherapy was associated with better survival (44 [84.6%] vs. 32 [36.4%]; hazard ratio [HR], 0.0363; confidence interval [CI], 0.197–0.670, p = 0.00199). Adjuvant chemotherapy and immunotherapy resulted in prolonged survival (24 [46.2%] vs. 12 [13.6%]; HR 0.474, CI 0.263–0.854, p = 0.013]. Systemic disease progression was associated with poor survival (36 [50%] vs. 71 [80.7%]; HR 5.975, CI 2.610–13.677, p < 0.001].ConclusionNeurosurgical resection is an appropriate treatment modality for patients with low KPS. Surgery may improve functional status and facilitate further tumor-specific treatment. Combined treatment with adjuvant radiotherapy and systemic therapy was associated with improved survival in this cohort of patients. Systemic tumor progression has been identified as an independent factor for a poor prognosis. There is almost no information regarding surgical and adjuvant treatment in patients with low KPS. Our paper provides novel data on clinical outcome and survival analysis of patients with BM who underwent surgical treatment.https://www.frontiersin.org/articles/10.3389/fonc.2023.1343500/fullKarnofsky performance statusneurosurgical resectionbrain metastasesoverall survivalsystemic tumor progression |
| spellingShingle | Maria Goldberg Michel G. Mondragon-Soto Ghaith Altawalbeh Lea Baumgart Jens Gempt Denise Bernhardt Denise Bernhardt Stephanie E. Combs Stephanie E. Combs Stephanie E. Combs Bernhard Meyer Amir Kaywan Aftahy Enhancing outcomes: neurosurgical resection in brain metastasis patients with poor Karnofsky performance score - a comprehensive survival analysis Frontiers in Oncology Karnofsky performance status neurosurgical resection brain metastases overall survival systemic tumor progression |
| title | Enhancing outcomes: neurosurgical resection in brain metastasis patients with poor Karnofsky performance score - a comprehensive survival analysis |
| title_full | Enhancing outcomes: neurosurgical resection in brain metastasis patients with poor Karnofsky performance score - a comprehensive survival analysis |
| title_fullStr | Enhancing outcomes: neurosurgical resection in brain metastasis patients with poor Karnofsky performance score - a comprehensive survival analysis |
| title_full_unstemmed | Enhancing outcomes: neurosurgical resection in brain metastasis patients with poor Karnofsky performance score - a comprehensive survival analysis |
| title_short | Enhancing outcomes: neurosurgical resection in brain metastasis patients with poor Karnofsky performance score - a comprehensive survival analysis |
| title_sort | enhancing outcomes neurosurgical resection in brain metastasis patients with poor karnofsky performance score a comprehensive survival analysis |
| topic | Karnofsky performance status neurosurgical resection brain metastases overall survival systemic tumor progression |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2023.1343500/full |
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