The Impact of Prolonged Mechanical Ventilation on Overall Survival in Patients With Surgically Treated Brain Metastases

Schuss, Patrick; Schäfer, Niklas; Bode, Christian; Borger, Valeri; Eichhorn, Lars; Giordano, Frank A.; Güresir, Erdem; Heimann, Muriel; Ko, Yon‐Dschun; Landsberg, Jennifer; Lehmann, Felix; Potthoff, Anna-Laura; Radbruch, Alexander; Schaub, Christina; Schwab, Katjana; Weller, Johannes; Vatter, Hartmut; Herrlinger, Ulrich; Schneider, Matthias

doi:10.3389/fonc.2021.658949

Cited by 14 publications

(20 citation statements)

References 17 publications

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“…Again, a higher preoperative CCI value is evident in the present patient collective with intra-tumoral hemorrhage. An increased burden of comorbid concomitant diseases is also associated with a higher incidence of postoperative complications, which can significantly influence the further survival of the affected patient ( 4 , 18 ). According to the definition of the CCI used here, existing diseases that require anticoagulant medication are also included (e.g., myocardial infarction, history of transient ischemic attacks) ( 19 ).…”

Section: Discussionmentioning

confidence: 99%

Preoperative Metastatic Brain Tumor-Associated Intracerebral Hemorrhage Is Associated With Dismal Prognosis

et al. 2021

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ObjectIntra-tumoral hemorrhage is considered an imaging characteristic of advanced cancer disease. However, data on the influence of intra-tumoral hemorrhage in patients with brain metastases (BM) remains scarce. We aimed at investigating patients with BM who underwent neurosurgical resection of the metastatic lesion for a potential impact of preoperative hemorrhagic transformation on overall survival (OS).MethodsBetween 2013 and 2018, 357 patients with BM were surgically treated at the authors’ neuro-oncological center. Preoperative magnetic resonance imaging (MRI) examinations were assessed for the occurrence of malignant hemorrhagic transformation.Results122 of 375 patients (34%) with BM revealed preoperative intra-tumoral hemorrhage. Patients with hemorrhagic transformed BM exhibited a median OS of 5 months compared to 12 months for patients without intra-tumoral hemorrhage. Multivariate analysis revealed preoperative hemorrhagic transformation as an independent and significant predictor for worsened OS.ConclusionsThe present study identifies preoperative intra-tumoral hemorrhage as an indicator variable for poor prognosis in patients with BM undergoing neurosurgical treatment.

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Section: Discussionmentioning

confidence: 99%

Preoperative Metastatic Brain Tumor-Associated Intracerebral Hemorrhage Is Associated With Dismal Prognosis

et al. 2021

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Section: Discussionmentioning

confidence: 99%

“…PMV has previously been identified as a meaningful prognostic factor in patients suffering from several tumor diseases ( 16 , 51 ). Recently, PMV of more than 48 hours has been reported to result in median OS of < 1 month in patients with surgically treated brain metastasis ( 16 ), therefore indicating that PMV constitutes a devastating prognostic factor in neurosurgical oncology. Similarly, PMV of more than 24 hours has been identified as an independent prognostic factor in patients undergoing surgery for glioblastoma, with a reported median OS of as low as 3 months ( 18 ).…”

Section: Discussionmentioning

confidence: 99%

“…PMV was defined as an invasive ventilation period of > 24 hours after initial spinal surgery ( 16 , 17 , 24 , 25 ). The comorbidity burden was measured using the Charlson comorbidity index (CCI) ( 26 , 27 ).…”

Section: Methodsmentioning

confidence: 99%

“…Nevertheless, surgical treatment may require prolonged postoperative intensive care, which could adversely affect the anticipated benefits of the surgery. Postoperative prolonged mechanical ventilation (PMV) has recently been used as an indicator variable for intensive care treatment in several diseases (15)(16)(17)(18). However, the impact of PMV in the field of surgery for SM has not been analyzed to date.…”

Section: Introductionmentioning

confidence: 99%

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Postoperative prolonged mechanical ventilation correlates to poor survival in patients with surgically treated spinal metastasis

Hamed

Brandecker²,

Rana³

et al. 2022

Front. Oncol.

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ObjectivePatients with spinal metastasis (SM) are at advanced stages of systemic cancer disease. Surgical therapy for SM is a common treatment modality enabling histopathological diagnosis and the prevention of severe neurological deficits. However, surgery for SM in this vulnerable patient cohort may require prolonged postoperative intensive care treatment, which could adversely affect the anticipated benefit of the surgery. We therefore assessed postoperative prolonged mechanical ventilation (PMV) as an indicator for intensive care treatment with regard to potential correlations with early postoperative mortality and overall survival (OS).MethodsBetween 2015 and 2019, 198 patients were surgically treated for SM at the author´s neurosurgical department. PMV was defined as postoperative mechanical ventilation of more than 24 hours. A multivariate analysis was performed to identify pre- and perioperative collectable predictors for 30 days mortality.ResultsTwenty out of 198 patients (10%) with SM suffered from postoperative PMV. Patients with PMV exhibited a median OS rate of 1 month compared to 12 months for patients without PMV (p < 0.0001). The 30 days mortality was 70% and after one year 100%. The multivariate analysis identified “PMV > 24 hrs” (p < 0.001, OR 0.3, 95% CI 0.02-0.4) as the only significant and independent predictor for 30 days mortality (Nagelkerke’s R2 0.38).ConclusionsOur data indicate postoperative PMV to significantly correlate to high early postoperative mortality rates as well as to poor OS in patients with surgically treated SM. These findings might encourage the initiation of further multicenter studies to comprehensively investigate PMV as a so far underestimated negative prognostic factor in the course of surgical treatment for SM.

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

Banat,

Potthoff,

Hamed

et al. 2024

J Cancer Res Clin Oncol

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Purpose Patients with spinal metastases (SM) from solid neoplasms typically exhibit progression to an advanced cancer stage. Such metastases can either develop concurrently with an existing cancer diagnosis (termed metachronous SM) or emerge as the initial indication of an undiagnosed malignancy (referred to as synchronous SM). The present study investigates the prognostic implications of synchronous compared to metachronous SM following surgical resection. Methods From 2015 to 2020, a total of 211 individuals underwent surgical intervention for SM at our neuro-oncology facility. We conducted a survival analysis starting from the date of the neurosurgical procedure, comparing those diagnosed with synchronous SM against those with metachronous SM. Results The predominant primary tumor types included lung cancer (23%), prostate cancer (21%), and breast cancer (11.3%). Of the participants, 97 (46%) had synchronous SM, while 114 (54%) had metachronous SM. The median overall survival post-surgery for those with synchronous SM was 13.5 months (95% confidence interval (CI) 6.1–15.8) compared to 13 months (95% CI 7.7–14.2) for those with metachronous SM (p = 0.74). Conclusions Our findings suggest that the timing of SM diagnosis (synchronous versus metachronous) does not significantly affect survival outcomes following neurosurgical treatment for SM. These results support the consideration of neurosurgical procedures regardless of the temporal pattern of SM manifestation.

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The Impact of Prolonged Mechanical Ventilation on Overall Survival in Patients With Surgically Treated Brain Metastases

Cited by 14 publications

References 17 publications

Preoperative Metastatic Brain Tumor-Associated Intracerebral Hemorrhage Is Associated With Dismal Prognosis

Preoperative Metastatic Brain Tumor-Associated Intracerebral Hemorrhage Is Associated With Dismal Prognosis

Postoperative prolonged mechanical ventilation correlates to poor survival in patients with surgically treated spinal metastasis

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

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