Prognostic factors in surgical treatment of solitary brain metastasis after resection of non-small-cell lung cancer

Patients with brain metastasis after resection of non-small-cell lung cance r usually have poor prognosis. A few such patients, however, survive for lo ng periods after surgical resection of brain metastases. To evaluate the pr ognostic factors in resection of solitary brain metastasis from non-small-c ell lung cancer, we reviewed 24 cases undergoing resection of solitary brai n metastasis after resection of the primary site from 1977 to 1993. The pat ient population consisted of 20 men and four women ranging in age from 40 t o 75 years old (average, 57.8 years old). None of the patients had systemic metastasis except in the brain at the time of brain surgery. The overall s urvival rates were 12.5% at 3 years and 8.3% at 5 years after brain surgery . The longest survival periods were 11.5 years after brain surgery and 15.4 years after lung surgery. The interval between lung and brain surgery (les s than or equal to 360 days vs. > 360 days), differentiation of primary can cer (poor vs. moderate), size of primary site (less than or equal to 5.0 cm vs. > 5.0 cm), and operation of primary site (lobectomy vs. pneumonectomy) significantly affected survival as shown by univariate analysis (P < 0.05) . Other clinical factors (age, gender, histology, T- and N-status, 'resecta bility with curative intent' of the primary site, location of the brain met astasis and postoperative radiation therapy) did not affect survival. Multi variate analysis using Cox's proportional hazards model indicated that an i nterval of more than 360 days between the two surgical procedures (hazard r atio = 0.2351, P = 0.0136) and lobectomy (hazard ratio = 0.5274, P = 0.0416 ) were independent prognostic factors. In conclusion, patients with solitar y brain metastasis from non-small-cell lung cancer without other organ meta stasis, in whom relapse in the brain occurred more than 1 year after resect ion of the primary site and in whom lobectomy was performed, should be trea ted surgically to maximize the chance ol. prolonged survival. (C) 1999 Else vier Science Ireland Ltd. All rights reserved.