{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T05:00:52Z","timestamp":1784696452420,"version":"3.55.0"},"reference-count":28,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,12,7]],"date-time":"2025-12-07T00:00:00Z","timestamp":1765065600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,12,7]],"date-time":"2025-12-07T00:00:00Z","timestamp":1765065600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl Journal of Cancer"],"published-print":{"date-parts":[[2026,4,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Brain metastases (BrMs) may present with intralesional or intracranial hemorrhage (ICH), yet risk factors and outcomes remain unclear. This monocentric cohort study at Germany's largest neurosurgical clinic included 973 adults undergoing BrM resection (2010\u20132024), with histopathologically confirmed etiologies and known tumor burden. Based on pre\u2010operative CT or MRI, 880 patients were categorized as non\u2010hemorrhagic (non\u2010hBrM), presenting with intralesional hemorrhage (hBrM), or with ICH of \u226530\u2009mm diameter (ICH\u2010BrM). Risk factors for hBrM and ICH\u2010BrM were assessed, and overall survival (OS) and progression\u2010free survival (PFS) were analyzed using Kaplan\u2010Meyer methods. Of 880 patients, 560 (63.6%) were non\u2010hBrM, 243 (27.6%) hBrM, and 77 (8.8%) ICH\u2010BrM. ICH\u2010BrM had larger tumor volume (21\u2009cm\n                    <jats:sup>3<\/jats:sup>\n                    , IQR 13\u201334) than hBrM (14\u2009cm\n                    <jats:sup>3<\/jats:sup>\n                    , IQR 6\u201328) and non\u2010hBrM (12\u2009cm\n                    <jats:sup>3<\/jats:sup>\n                    , IQR 6\u201321) (\n                    <jats:italic>p<\/jats:italic>\n                    <jats:sub>adjust<\/jats:sub>\n                    \u2009=\u2009.017), correlated with lower post\u2010op Karnofsky index (\n                    <jats:italic>p<\/jats:italic>\n                    <jats:sub>adjust<\/jats:sub>\n                    \u2009=\u2009.047), dsGPA score (\n                    <jats:italic>p<\/jats:italic>\n                    <jats:sub>adjust<\/jats:sub>\n                    \u2009=\u2009.032), and more BrMs (\n                    <jats:italic>p<\/jats:italic>\n                    <jats:sub>adjust<\/jats:sub>\n                    \u2009=\u2009.004). Pre\u2010operative antithrombotic use did not differ between groups (\n                    <jats:italic>p<\/jats:italic>\n                    <jats:sub>adjust<\/jats:sub>\n                    \u2009=\u2009.32). Melanoma was more common in hBrM (27.8%) and ICH\u2010BrM (38.0%), predicting ICH (OR 2.95,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u2009.001) along with NSCLC (OR 1.64,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u2009.001). ICH did not independently predict worse OS (HR 1.23,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u2009.38). Worse OS was linked to larger tumor volume (HR 1.35,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u2009.002), extracranial metastases (HR 1.77,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u2009.001), and older age (HR 1.53,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u2009.001), while KPS &gt;80% (HR 0.77,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u2009.01), solitary BrM (HR 0.62,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u2009.002), and adjuvant treatments (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u2009.001) predicted improved OS. ICH is associated with larger tumors and melanoma but is not an independent OS predictor. Tumor burden, extracranial metastases, and adjuvant treatments drive BrM survival.\n                  <\/jats:p>","DOI":"10.1002\/ijc.70250","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T07:25:54Z","timestamp":1765178754000},"page":"2120-2138","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Outcomes and risk factors of hemorrhage in patients with resected brain metastases"],"prefix":"10.1002","volume":"158","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-2187-0895","authenticated-orcid":false,"given":"Melisa S.","family":"Guelen","sequence":"first","affiliation":[{"name":"Department of Neurosurgery Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt\u2010Universit\u00e4t zu Berlin  Berlin Germany"},{"name":"Institute of Neuroradiology Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt\u2010Universit\u00e4t zu Berlin  Berlin Germany"},{"name":"Athinoula A. Martinos Center for Biomedical Imaging Massachusetts General Hospital and Harvard Medical School  Charlestown Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiarash","family":"Ferdowssian","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt\u2010Universit\u00e4t zu Berlin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niklas","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt\u2010Universit\u00e4t zu Berlin  Berlin Germany"},{"name":"Institute of Neuroradiology Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt\u2010Universit\u00e4t zu Berlin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hava N.","family":"Celik","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt\u2010Universit\u00e4t zu Berlin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Dell'Orco","sequence":"additional","affiliation":[{"name":"Institute of Neuroradiology Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt\u2010Universit\u00e4t zu Berlin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Semil","family":"Eminovic","sequence":"additional","affiliation":[{"name":"Department of Radiology Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt\u2010Universit\u00e4t zu Berlin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anton","family":"Fr\u00fch","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt\u2010Universit\u00e4t zu Berlin  Berlin Germany"},{"name":"BIH Biomedical Innovation Academy, BIH Charit\u00e9 Junior Digital Clinician Scientist Program Berlin Institute of Health at Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Majd","family":"Samman","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt\u2010Universit\u00e4t zu Berlin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00fcliz","family":"Acker","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt\u2010Universit\u00e4t zu Berlin  Berlin Germany"},{"name":"BIH Biomedical Innovation Academy, BIH Charit\u00e9 Junior Digital Clinician Scientist Program Berlin Institute of Health at Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arend","family":"Koch","sequence":"additional","affiliation":[{"name":"Department of Neuropathology Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt\u2010Universit\u00e4t zu Berlin  Berlin 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