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Background <p>Brain metastases (BM) from non-small cell lung cancer (NSCLC) are associated with limited prognosis. Although surgical resection is part of multimodal management, the prognostic relevance of surgical intracranial tumor load reduction in the era of stereotactic radiotherapy and modern systemic therapies remains unclear.</p> Methods <p>This retrospective bicentric cohort study included 285 adults with histologically confirmed NSCLC who underwent BM resection. Pre- and postoperative MRI were used for volumetric assessment. Gross-total resection (GTR) was defined as the absence of measurable postoperative residual volume (RV). Outcomes were overall survival (OS) and intracranial progression-free survival (iPFS). Multivariable Cox regression models adjusted for age, preoperative performance status, extracranial metastases, number of BM, and postoperative radiotherapy and systemic therapies.</p> Results <p>Median OS was 14.3 months and median iPFS was 8.0 months. GTR was achieved in 96 patients (34% overall; 38% of patients with evaluable volumetric imaging) and was independently associated with longer OS (adjusted HR, 0.51; 95% CI, 0.30–0.86) and prolonged iPFS (adjusted HR, 0.55; 95% CI, 0.31–0.99). Postoperative RV, analyzed continuously or categorically, showed no consistent association with OS or iPFS. The benefit of GTR was most pronounced in patients with single BM or without extracranial metastases.</p> Conclusion <p>Achieving complete intracranial tumor resection, rather than the amount of postoperative residual volume, was consistently associated with improved survival and intracranial disease control. These findings support the clinical relevance of GTR in selected NSCLC-BM patients and may inform patient counselling and surgical decision-making, while warranting further investigation in patients with multifocal but safely resectable intracranial disease.</p>

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Postoperative absence of residual intracranial tumor volume is associated with improved survival and intracranial disease control in non-small cell lung cancer brain metastases

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月22日

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  • Jacopo Bellomo,
  • Meltem Gönel,
  • Jonathan Sutter,
  • Anna Maria Zeitlberger,
  • Maria Nikolaeva,
  • Tristan Schmidlechner,
  • Vittorio Stumpo,
  • Luis Padevit,
  • Victor Egon Staartjes,
  • Flavio Vasella,
  • Jorn Fierstra,
  • Nicolin Hainc,
  • Isabelle Opitz,
  • Michael Weller,
  • Emilie Le Rhun,
  • Oliver Bozinov,
  • Luca Regli,
  • Carlo Serra,
  • Marian Christoph Neidert,
  • Stefanos Voglis

摘要

Background

Brain metastases (BM) from non-small cell lung cancer (NSCLC) are associated with limited prognosis. Although surgical resection is part of multimodal management, the prognostic relevance of surgical intracranial tumor load reduction in the era of stereotactic radiotherapy and modern systemic therapies remains unclear.

Methods

This retrospective bicentric cohort study included 285 adults with histologically confirmed NSCLC who underwent BM resection. Pre- and postoperative MRI were used for volumetric assessment. Gross-total resection (GTR) was defined as the absence of measurable postoperative residual volume (RV). Outcomes were overall survival (OS) and intracranial progression-free survival (iPFS). Multivariable Cox regression models adjusted for age, preoperative performance status, extracranial metastases, number of BM, and postoperative radiotherapy and systemic therapies.

Results

Median OS was 14.3 months and median iPFS was 8.0 months. GTR was achieved in 96 patients (34% overall; 38% of patients with evaluable volumetric imaging) and was independently associated with longer OS (adjusted HR, 0.51; 95% CI, 0.30–0.86) and prolonged iPFS (adjusted HR, 0.55; 95% CI, 0.31–0.99). Postoperative RV, analyzed continuously or categorically, showed no consistent association with OS or iPFS. The benefit of GTR was most pronounced in patients with single BM or without extracranial metastases.

Conclusion

Achieving complete intracranial tumor resection, rather than the amount of postoperative residual volume, was consistently associated with improved survival and intracranial disease control. These findings support the clinical relevance of GTR in selected NSCLC-BM patients and may inform patient counselling and surgical decision-making, while warranting further investigation in patients with multifocal but safely resectable intracranial disease.