Neurosurgical Resection Benefits Lung Cancer Brain Metastases Patients with Poor KPS

Overview

This multicenter retrospective study evaluated 386 lung cancer patients with brain metastases and poor Karnofsky performance status (KPS ≤ 70). Findings demonstrate that neurosurgical resection provides a significant survival benefit in this population, challenging the traditional exclusion of poor KPS patients from surgery.

Background

Lung cancer is the leading cause of brain metastases, which are associated with high morbidity and limited survival. Karnofsky performance status (KPS) is widely used to assess functional status and predict outcomes in cancer patients, with poor KPS historically linked to worse prognosis and often used as an exclusion criterion in clinical trials. Surgical resection is a standard treatment for brain metastases in patients with good KPS, but its role in patients with poor KPS remains unclear. Advances in surgical techniques warrant re-evaluation of surgical indications in this subgroup.

Data Highlights

Key Findings

• Patients with lung cancer brain metastases and poor KPS (≤70) traditionally have poor outcomes.
• Neurosurgical resection significantly improves overall survival in patients with poor KPS compared to non-surgical management.
• Propensity score matching and inverse probability of treatment weighting were used to adjust for baseline differences and reduce bias.
• Multivariate Cox regression confirmed surgery as an independent positive prognostic factor for survival in this subgroup.
• Findings challenge the conventional exclusion of poor KPS patients from surgical consideration for brain metastases.

Clinical Implications

Clinicians should consider neurosurgical resection as a viable treatment option for lung cancer patients with brain metastases even when pretreatment KPS is ≤ 70. Surgical intervention may confer survival benefits and should not be withheld solely based on suboptimal performance status. Careful patient selection and multidisciplinary evaluation remain essential.

Conclusion

Neurosurgical resection offers a survival advantage in lung cancer patients with brain metastases and poor KPS, suggesting that poor functional status alone should not preclude surgical treatment. These results support revisiting surgical indications in this patient population.

References

1. Sun Yat-sen University Cancer Center, 2021 -- Multicenter retrospective study on lung cancer brain metastases and KPS