CLTR-02 OUTCOMES OF SURGICAL RESECTION IN PATIENTS WITH MORE THAN ONE BRAIN METASTASIS

[Surgical treatment of primary multiple lung cancer in elderly and senile patients].

OBJECTIVE To evaluate early and long-term outcomes of surgical treatment for primary multiple lung cancer (PMLC) in elderly and senile patients and to characterize key aspects of perioperative management. MATERIAL AND METHODS A retrospective single-center study included 12 patients with verified PMLC who underwent surgery between 2010 and 2022. They were classified as elderly (60-75 years; n=9) or senile (76-85 years; n=3) according to the WHO classification. PMLC was confirmed using the Martini-Melamed criteria modified by Antakli and the Warren-Gates criteria. Patients underwent anatomical (lobectomy, bilobectomy, pneumonectomy) or sublobar (segmentectomy, wedge resection) lung resections, predominantly via video-assisted thoracic surgery. Postoperative complications were assessed using the Clavien-Dindo classification. Disease-free and overall survival after the second surgery were analyzed using the Kaplan-Meier method. RESULTS R0 resection was achieved in all patients. After surgery for the second primary lesion, postoperative complications occurred in 75% of cases. The most common events were prolonged air leak, residual pleural cavities, COPD exacerbation, and cardiac arrhythmias. No in-hospital mortality was observed. Mean postoperative hospital-stay was 8.4±2.1 days after the first surgery and 10.2±2.5 days after the second surgery. Following the second resection, 1-, 3- and 5-year disease-free survival rates were 93.9%, 84.4%, and 67.6%, respectively. Overall survival rates were 99.6%, 87.4%, and 76.6%, respectively. No significant differences in survival were found between lobectomy and sublobar resections. These findings should be interpreted as descriptive due to small sample size. CONCLUSION In carefully selected elderly and senile patients, surgical treatment of PMLC provides acceptable rates of postoperative morbidity and 5-year survival comparable to published data. Anatomical resections are preferable in patients with sufficient functional reserves. In those with limited cardiopulmonary function, sublobar resections are an acceptable alternative.

What Is the 5-year Survival of Patients With or Without Surgery in Spinal Metastatic Disease?

BACKGROUND Despite advances in imaging, nonoperative management, immunotherapy, and surgery over the last 15 years, sizable improvements in survival for patients with spinal metastases have not been observed. Older studies may no longer be accurate in light of rapid technological improvements. The performance of scoring utilities, such as the Skeletal Oncology Research Group (SORG) nomogram and the New England Spinal Metastasis Score (NESMS), has also not been investigated beyond the first year of treatment. QUESTIONS/PURPOSES (1) What was the 5-year survival of patients who presented with spinal metastases and were treated with or without surgery according to contemporary indications, stratified by tumor type? (2) How effective were the SORG and NESMS at prognosticating survival up to 5 years after presentation? METHODS We used our healthcare system's registry to identify patients treated operatively and nonoperatively for spinal metastatic disease (full surveillance inclusive of follow-up from January 1, 2017 to December 31, 2025). Data included in this study were drawn from two large, tertiary academic hospitals in a single major city, as well as from two local affiliate community hospitals. This study environment allowed for capturing a broad sample of tumor and treatment types, which is representative of the complex care associated with spinal metastatic disease. Query of the registry identified 997 patients; 71 patients were excluded because their initial presentation was < 5 years from the final data date; they were therefore ineligible for 5-year evaluation. Those whose initial presentation was < 5 years from study initiation, but had died, were maintained. One percent of patients (13 of 926) were eligible for 5-year follow-up but had an unknown vital status. Missing data were uncommon, with no variable having > 1% missingness. Sixty percent (551) of patients were treated with surgery. Overall, the surgical and nonoperative cohorts were comparable regarding demographic and clinical characteristics. Patients treated with surgery were slightly older than those treated nonoperatively (62 years versus 59 years; p < 0.01). The nonoperative cohort had a female predominance, whereas the surgical cohort did not (56% versus 43%; p < 0.001). Both cohorts had a median CCI score of 8 (p = 0.7). There were no differences in the use of immunotherapy between those treated with surgery (29%) and those treated with nonoperative care (27%; p = 0.6). We evaluated survival over the course of 5 years after presentation. In this registry, death is captured through a combination of medical record documentation as well as linkage to external state and federal sources. We performed multivariable Cox proportional hazards regression analysis for 5-year survival using each spinal metastasis prognostic score. The SORG is a prognostic score from 0 to 100 that represents the calculated probability of survival. NESMS ranges from 0 to 3, with higher scores representing a more favorable clinical state. Separate models were generated using SORG and NESMS as the primary explanatory variable, respectively. Both models adjusted for age, sex, race, comorbidity burden, immunotherapy, and surgical treatment. RESULTS At the 5-year time point, the Kaplan-Meier survival estimate was 8.9% (95% confidence interval [CI] 7.2% to 10.9%). Patients with lung cancer demonstrated the lowest survival rate among the discrete tumor types at every time point. When accounting for age, sex, race, comorbidities, immunotherapy, and treatment type, the SORG score was associated with survival (HR 0.98 [95% CI 0.98 to 0.99]; p < 0.001), meaning that each single-point increase in SORG score was associated with a 2% decreased likelihood of mortality. When controlling for the same variables, the NESMS was also associated with 5-year survival (HR 0.61 [95% CI 0.56 to 0.66]; p < 0.001), meaning that each 1-point increase in SORG score was associated with 40% reduction in mortality. CONCLUSION We present long-term survival for patients with spinal metastases in the modern period of spine oncology care, stratified by primary cancer type. Although mortality rates over time remain high, our study is the first to show that approximately 10% of patients will survive 5 years or longer. These data can aid in patient counseling as well as surgical decision-making. Understanding the 5-year survival forecast for patients with spinal metastases will help physicians tailor treatment decisions and can help surgeons prioritize minimizing surgical morbidity with shorter, simpler operations, when possible. Both the SORG and NESMS can be used to support long-term estimations regarding survival. LEVEL OF EVIDENCE Level III, therapeutic study.

Surgical resection and survival in second primary intrahepatic cholangiocarcinoma: a population-based cohort study

Second primary intrahepatic cholangiocarcinoma (SP-ICC) represents a growing clinical challenge in the era of improved cancer survivorship. The survival impact of formal surgical resection in this population remains unclear. This study aimed to evaluate the association between surgical resection and survival outcomes in patients with SP-ICC. We conducted a population-based cohort study using the Surveillance, Epidemiology, and End Results database (2000–2022). Patients with SP-ICC were stratified by cancer-directed surgical resection status. Propensity score matching (1:1) was performed to balance baseline characteristics. Overall survival (OS) and cancer-specific survival (CSS) were assessed using Kaplan–Meier analysis and multivariable Cox regression models. Multiple Imputation by Chained Equations (MICE), competing risk analysis (Fine–Gray), and inverse probability of treatment weighting (IPTW) were performed as sensitivity analyses. Among 2,871 eligible patients, 702 (24.5%) underwent surgical resection. Younger age, earlier stage, and smaller tumor size were independent predictors for receiving surgery. After matching, 1,294 patients (647 per group) were included. In the matched cohort, median OS was 42.0 months (95% CI, 37.0–47.0) in the surgery group versus 9.0 months (95% CI, 8.0–10.0) in the non-surgery group ( P  < 0.001). Surgical resection was independently associated with improved OS (adjusted hazard ratio [aHR], 0.27; 95% CI, 0.22–0.32; P  < 0.001) and reduced cancer-specific mortality (adjusted subdistribution HR [aSHR], 0.40; 95% CI, 0.34–0.49; P  < 0.001). These results remained robust across landmark, MICE (aHR, 0.30; 95% CI, 0.27–0.34), IPTW, and subgroup analyses. In this population-based study incorporating rigorous causal adjustment, surgical resection was independently associated with substantially prolonged survival in patients with SP-ICC. Conventional tumor stage and grade remained primary prognostic determinants, supporting careful multidisciplinary evaluation for surgical candidacy in this population.

Postoperative functional status as the primary determinant of survival in surgically treated brain metastases: A retrospective cohort analysis

Aim: Brain metastases (BM) are an increasing oncological challenge due to improved systemic cancer survival. Surgical resection is essential for symptom control and diagnosis; however, survival outcomes remain heterogeneous. The objective of the current investigation was to evaluate the clinical and surgical determinants that impact overall survival (OS) outcomes in a cohort of patients undergoing resection for BM.Material and Methods: A total of 158 adult cases treated surgically for intracranial metastases from January 2018 to December 2024 were systematically analyzed through a retrospective institutional review. Demographic, clinical, radiological, and surgical variables were analyzed. OS was the primary endpoint. The Kaplan-Meier method was utilized for survival estimation, while the influence of various covariates on prognosis was examined through Cox proportional hazards modeling. The Tarone-Ware test was used to assess early survival differences. Results: Our analysis revealed a median survival time of 6.0 months. Initial univariable screening showed that survival was significantly linked to factors such as patient age, gender, adjuvant therapies, and KPS measured at different perioperative stages. In the revised multivariable analysis, postoperative KPS (HR: 0.974, 95% CI: 0.962-0.986, p

Surgical treatment of elderly NSCLC patients: Long-term outcomes from a single-center cohort.

OBJECTIVES The management of non-small cell lung cancer (NSCLC) in elderly patients is an increasing clinical challenge. This study compared postoperative and oncologic outcomes between anatomical and wedge resections in patients aged ≥75 years. Primary endpoints were overall survival (OS) and disease-free survival (DFS). Secondary endpoints included predictors of postoperative complications and survival. METHODS This retrospective study included 393 patients aged ≥75 years who underwent surgery for NSCLC between 2010 and 2019. Among them, 103 underwent wedge resection and 290 anatomical resection. Demographic, clinical, surgical, and oncologic data were collected. Multivariate analyses identified predictors of complications, OS, and DFS. RESULTS Patients undergoing wedge resection were older and had higher comorbidity scores but experienced shorter operative times and fewer complications. Five-year OS and DFS were 53.2% and 56.8%, respectively, with no significant differences between groups. Reduced FEV1, open surgery, and longer operative time independently predicted postoperative complications. Male sex, higher comorbidity burden, smoking, reduced FEV1, and postoperative complications were associated with worse OS. CONCLUSIONS Wedge resection represents a safe alternative to anatomical resection in selected elderly patients, with comparable survival outcomes and reduced perioperative burden. Careful preoperative selection remains essential.

Long-term outcomes after adjuvant radiotherapy in adult spinal ependymomas: a multicenter study by the trod Neuro-Oncology research group (07 − 005)