Impact of pre-OP independence in patients with limited brain metastases on long-term survival
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RESEARCH ARTICLE
Open Access
Impact of pre-OP independence in patients with limited brain metastases on long-term survival Annalen Bleckmann1,2,3, Benjamin Kirchner1, Manuel Nietert2, Micha Peeck1,3* , Marko Balkenhol4, Daniela Egert4, T. Veit Rohde5, Tim Beißbarth2 and Tobias Pukrop1,6
Abstract Background: Brain metastasis represents a major complication with a significantly shorter overall survival of many oncological diseases, in particular of lung cancer, breast cancer and malignant melanoma patients. However, despite the poor prognosis, sometimes clinical decision-making, between on the one hand not to harm the patient and on the other hand not withholding a potential therapeutic option, is very challenging. Thus the aim of this retrospective study was to compare various scores, including scores for activities of daily living (ADL) before resection of brain metastases and to analyse their impact on survival. Methods: Our single institution retrospective patient cohort (N = 100) with a median age of 63.6 years, which had all undergone resection of one or more brain metastases, was categorized using the original patient files. The cohort includes 52 patients with lung cancer, 27 patients with breast cancer, 8 patients with colorectal carcinoma and 13 patients with kidney cancer. To categorize, we used different score systems which were capable to evaluate the patient in relation to self-sufficiency, activity and self-determination as part of ADL. The retrospective analysis includes the ECOG-Status, Karnofsky-Index, Barthel-Index, ASA-Classification and Katz-Index. Pre-processing and the analysis of the data was implemented using KNIME, where we used the R-plugin nodes to perform the final statistical tests with R. Results: Our analysis reveals that most of the ADL scores we tested are able to give a reliable prediction on overall survival after brain metastasis surgery. The survival rates decrease significantly with a lower score in all tested score systems, with the exception of the ASA-Risk score. In particular, the Katz Index < 6 was identified to have a significant correlation with a lower cancer specific survival (CSS) (HR 3.33, 95%-CI [2.17–5.00]; p-Value = 9.6*10− 9), which is easy to use and has reproducible measurements. Conclusions: Pre-operative independence assessment by indices of ADL represents a predictor for overall survival after resection of brain metastases. Especially the easily, objectively and rapidly applicable Katz-Score is a very helpful tool to assess the pre-operative status, which could be additionally included in clinical decision making in daily practice. Keywords: Brain metastases, Activities of daily living, Independence, Surgery, Katz-index, GPA * Correspondence: [email protected] 1 Clinic for Hematology/Medical Oncology, University Medical Center Göttingen, 37099 Göttingen, Germany 3 Medical Clinic A, Haematology, Haemostasiology, Oncology and Pulmonology, University Hospital Münster, 48149 Münster, Germany Full list of author information is available at the end of th
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