Ichiyo Shibahara1, Masayuki Kanamori2, Takashi Watanabe3, Akihiro Utsunomiya4, Hiroyoshi Suzuki5, Ryuta Saito6, Yukihiko Sonoda7, Hidefumi Jokura8, Hiroshi Uenohara4, Teiji Tominaga6. 1. Department of Neurosurgery, National Hospital Organization Sendai Medical Center, Sendai, Japan; Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan. 2. Department of Neurosurgery, National Hospital Organization Sendai Medical Center, Sendai, Japan; Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan. Electronic address: mkanamori@med.tohoku.ac.jp. 3. Department of Hospital Medicine, JCHO Sendai Hospital, Sendai, Japan. 4. Department of Neurosurgery, National Hospital Organization Sendai Medical Center, Sendai, Japan. 5. Department of Pathology and Laboratory Medicine, National Hospital Organization Sendai Medical Center, Sendai, Japan. 6. Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan. 7. Department of Neurosurgery, Yamagata University Graduate School of Medicine, Yamagata, Japan. 8. Department of Neurosurgery, Jiro Suzuki Memorial Gamma House, Furukawa Seiryo Hospital, Osaki, Japan.
Abstract
OBJECTIVE: The purpose of this study was to clarify clinical features, outcomes, and the role of tumor resection in precocious, synchronous, and metachronous brain metastases. METHODS: Brain metastases were found before primary cancer detection in the precocious group, within 2 months after primary cancer detection in the synchronous group, and 2 months or later after primary cancer detection in the metachronous group. RESULTS: Of 471 patients with brain metastases, 93 (20%) were included in the precocious group, 76 (16%) in the synchronous group, and 302 (64%) in the metachronous group. The precocious group tended to be symptomatic, show a low Karnofsky Performance Status, and have a large single tumor, infrequent extracranial metastases, and frequent tumor resection compared with the other 2 groups. There were no differences in overall survival from the detection of brain metastases among the 3 groups in univariate and multivariate analyses. Of 471 cases, 97 (21%) underwent surgeries. Among this surgical cohort, overall survival from surgery was significantly shorter in the precocious group than in the metachronous group (P = 0.039). After adjustment for age, sex, tumor size, primary cancer, and the Graded Prognostic Assessment score, the hazard ratio for metachronous metastases was 0.52 (confidence interval, 0.29-0.95; P = 0.035). CONCLUSIONS: The timing of brain metastasis diagnosis is not a modifiable factor but affects patient demographics and treatment strategies. In particular, the precocious group is a unique subset of brain metastases that require special consideration during clinical decision making.
OBJECTIVE: The purpose of this study was to clarify clinical features, outcomes, and the role of tumor resection in precocious, synchronous, and metachronous brain metastases. METHODS:Brain metastases were found before primary cancer detection in the precocious group, within 2 months after primary cancer detection in the synchronous group, and 2 months or later after primary cancer detection in the metachronous group. RESULTS: Of 471 patients with brain metastases, 93 (20%) were included in the precocious group, 76 (16%) in the synchronous group, and 302 (64%) in the metachronous group. The precocious group tended to be symptomatic, show a low Karnofsky Performance Status, and have a large single tumor, infrequent extracranial metastases, and frequent tumor resection compared with the other 2 groups. There were no differences in overall survival from the detection of brain metastases among the 3 groups in univariate and multivariate analyses. Of 471 cases, 97 (21%) underwent surgeries. Among this surgical cohort, overall survival from surgery was significantly shorter in the precocious group than in the metachronous group (P = 0.039). After adjustment for age, sex, tumor size, primary cancer, and the Graded Prognostic Assessment score, the hazard ratio for metachronous metastases was 0.52 (confidence interval, 0.29-0.95; P = 0.035). CONCLUSIONS: The timing of brain metastasis diagnosis is not a modifiable factor but affects patient demographics and treatment strategies. In particular, the precocious group is a unique subset of brain metastases that require special consideration during clinical decision making.
Authors: Christopher P Wardell; Emilie Darrigues; Annick De Loose; Madison P Lee; Murat Gokden; Issam Makhoul; Alan J Tackett; Analiz Rodriguez Journal: Cancers (Basel) Date: 2021-11-09 Impact factor: 6.639