Survival after resection of brain metastasis: impact of synchronous versus metachronous metastatic disease

Abstract

Purpose Patients with brain metastasis (BM) from solid tumors are in an advanced stage of cancer. BM may occur during a known oncological disease (metachronous BM) or be the primary manifestation of previously unknown cancer (synchronous BM). The time of diagnosis might decisively impact patient prognosis and further treatment stratification. In the present study, we analyzed the prognostic impact of synchronous versus (vs.) metachronous BM occurrence following resection of BM. Methods Between 2013 and 2018, 353 patients had undergone surgical therapy for BM at the authors’ neuro-oncological center. Survival stratification calculated from the day of neurosurgical resection was performed for synchronous vs. metachronous BM diagnosis. Results Non-small-cell lung carcinoma (NSCLC) was the most common tumor entity of primary site (43%) followed by gastrointestinal cancer (14%) and breast cancer (13%). Synchronous BM occurrence was present in 116 of 353 patients (33%), metachronous BM occurrence was present in 237 of 353 patients (67%). NSCLC was significantly more often diagnosed via resection of the BM (56% synchronous vs. 44% metachronous situation, p = 0.0001). The median overall survival for patients with synchronous BM diagnosis was 12 months (95% confidence interval (CI) 7.5–16.5) compared to 13 months (95% CI 9.6–16.4) for patients with metachronous BM diagnosis (p = 0.97). Conclusions The present study indicates that time of BM diagnosis (synchronous vs. metachronous) does not significantly impact patient survival following surgical therapy of BM. These results suggest that the indication for neurosurgical BM resection should be made regardless of a synchronous or a metachronous time of BM occurrence.

Analysis of prognostic factors and the role of epilepsy in neurosurgical patients with brain metastases

“…However, the heterogeneous primary tumor landscape and the small sample size of the present study hinder drawing a firm conclusion. [ 17 ] It was also analyzed how the genesis of the epileptic seizures is influenced by BMs localization, and it was confirmed the well-documented data that the temporal localization correlates the most with the presence seizures at the clinical onset. Interestingly, the occipital localization was also highly correlated to seizures, as in a few other studies.…”

Brain metastases: Comparing clinical radiological differences in patients with lung and breast cancers treated with surgery

“… 29 The time of synchronous or metachronous presentation could impact prognosis and thus decisions between conservative or surgical treatment. 30 This relates to some studies done in NSCLC on prognosis, which is more unfavorable in patients with synchronous metastases, who have a median survival of 2.9 months, while metachronous metastases have a median survival of 3.4 months. 31 The average interval between initial cancer diagnosis and identification of BM is short for lung cancer with a range of 2–9 months, with >50 % of patients with lung cancer being diagnosed with a BM within the first year after initial diagnosis.…”

Synchronous versus metachronous spinal metastasis: a comparative study of survival outcomes following neurosurgical treatment

“…Patients were categorized into two distinct cohorts for further analysis: those with SM diagnosed as a manifestation of a previously known cancer (metachronous presentation) and those with a new diagnosis of SM as the initial indication of an undiscovered cancer (synchronous presentation) (Potthoff et al 2023 ).…”