{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T04:49:15Z","timestamp":1791607755132,"version":"4.3.4"},"reference-count":34,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Brain metastases are the most common malignant intracranial tumors and remain associated with poor survival despite advances in multimodal treatment. This study aimed to evaluate the associations between clinical, radiological, surgical, and perioperative characteristics and outcomes in patients undergoing surgical resection of brain metastases. Materials and Methods: This retrospective single-center cohort study included 378 consecutive adult patients who underwent resection of histopathologically confirmed brain metastases between 2015 and 2023. Overall survival was estimated using the Kaplan\u2013Meier method, and differences between groups were assessed using the log-rank test. Factors associated with overall survival were evaluated using univariable and multivariable Cox proportional hazards regression. Binary logistic regression was used to evaluate factors associated with 30-day mortality. Results: Median overall survival was 11.3 months, the one-year survival rate was 45.5%, and 18 patients (4.8%) died within 30 days after surgery. In the adjusted logistic regression model, preoperative KPS &lt; 80, hydrocephalus, postoperative hematoma, and postoperative pneumonia were associated with higher odds of 30-day mortality. In the multivariable Cox regression analysis, increasing age, preoperative KPS &lt; 80, tumor volume \u2265 9 cm3, hydrocephalus, wound complications, and postoperative KPS deterioration were independently associated with shorter overall survival. Subtotal versus total resection was not significantly associated with overall survival after adjustment. Conclusions: Several preoperative and postoperative characteristics were associated with early mortality and overall survival in this surgically selected cohort. These findings emphasize the importance of careful patient selection, preservation of functional status, optimization of perioperative care, and prevention of postoperative complications.<\/jats:p>","DOI":"10.3390\/cancers18193157","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T16:33:12Z","timestamp":1790699592000},"page":"3157","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Early and Late Prognostic Factors in Patients with Resected Brain Metastases"],"prefix":"10.3390","volume":"18","author":[{"given":"Dan M.","family":"Visarion","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Department of Neurosurgery, \u201cBagdasar-Arseni\u201d Clinical Emergency Hospital, 041915 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6016-0186","authenticated-orcid":false,"given":"Ioana","family":"Petrescu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, \u201cBagdasar-Arseni\u201d Clinical Emergency Hospital, 041915 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8488-4250","authenticated-orcid":false,"given":"Viorel M.","family":"Pruna","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Department of Neurosurgery, \u201cBagdasar-Arseni\u201d Clinical Emergency Hospital, 041915 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radu M.","family":"Gorgan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1580","DOI":"10.1212\/CON.0000000000000551","article-title":"Epidemiology, Treatment, and Complications of Central Nervous System Metastases","volume":"23","author":"Pruitt","year":"2017","journal-title":"Continuum"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1007\/s11912-011-0203-y","article-title":"Epidemiology of brain metastases","volume":"14","author":"Nayak","year":"2012","journal-title":"Curr. Oncol. Rep."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1038\/s41572-018-0055-y","article-title":"Brain metastases","volume":"5","author":"Achrol","year":"2019","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"150","DOI":"10.4143\/crt.2021.306","article-title":"Long-term Survival in Non-Small Cell Lung Cancer Patients with Metachronous Brain-Only Oligorecurrence Who Underwent Definitive Treatment","volume":"54","author":"Kim","year":"2022","journal-title":"Cancer Res. Treat."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1332","DOI":"10.1016\/j.annonc.2021.07.016","article-title":"EANO-ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up of patients with brain metastasis from solid tumours","volume":"32","author":"Guckenberger","year":"2021","journal-title":"Ann. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e000024","DOI":"10.1136\/esmoopen-2015-000024","article-title":"Descriptive statistical analysis of a real life cohort of 2419 patients with brain metastases of solid cancers","volume":"1","author":"Berghoff","year":"2016","journal-title":"ESMO Open"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"vdaa015","DOI":"10.1093\/noajnl\/vdaa015","article-title":"Medical management of brain metastases","volume":"2","author":"Lauko","year":"2020","journal-title":"Neuro-Oncol. Adv."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"8046","DOI":"10.1038\/s41598-021-87357-x","article-title":"Radiotherapy for brain metastasis and long-term survival","volume":"11","author":"Park","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.neuchi.2021.04.001","article-title":"Brain metastases: An update on the multi-disciplinary approach of clinical management","volume":"68","author":"Mitchell","year":"2022","journal-title":"Neurochirurgie"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1200\/JCO.2010.30.1655","article-title":"Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: Results of the EORTC 22952-26001 study","volume":"29","author":"Kocher","year":"2011","journal-title":"J. Clin. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"E8","DOI":"10.3171\/2023.5.FOCUS23198","article-title":"Preoperative frailty and 30-day mortality after resection of brain metastases: A multicenter surgical registry analysis of 11,038 patients","volume":"55","author":"Skandalakis","year":"2023","journal-title":"Neurosurg. Focus"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/1748-717X-6-23","article-title":"Validation of the new Graded Prognostic Assessment scale for brain metastases: A multicenter prospective study","volume":"6","author":"Villa","year":"2011","journal-title":"Radiat. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1200\/JCO.2011.38.0527","article-title":"Summary report on the graded prognostic assessment: An accurate and facile diagnosis-specific tool to estimate survival for patients with brain metastases","volume":"30","author":"Sperduto","year":"2012","journal-title":"J. Clin. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/j.ijsu.2017.05.033","article-title":"Prognostic factors in patients treated with surgery for brain metastases: A single-center retrospective analysis of 125 patients","volume":"44","author":"Liu","year":"2017","journal-title":"Int. J. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1007\/s00066-013-0442-y","article-title":"Brain metastasis. Prognostic value of the number of involved extracranial organs","volume":"189","author":"Rades","year":"2013","journal-title":"Strahlenther. Onkol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1007\/s00701-012-1606-8","article-title":"Retrospective study of 127 surgically treated patients with multiple brain metastases: Indication, prognostic factors, and outcome","volume":"155","author":"Schackert","year":"2013","journal-title":"Acta Neurochir."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1007\/s11060-013-1273-5","article-title":"Risk factors for early death after surgery in patients with brain metastases: Reevaluation of the indications for and role of surgery","volume":"116","author":"Arita","year":"2014","journal-title":"J. Neuro-Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e1557","DOI":"10.1016\/j.wneu.2018.11.100","article-title":"Neurosurgical Resection and Stereotactic Radiation Versus Stereotactic Radiation Alone in Patients with a Single or Solitary Brain Metastasis","volume":"122","author":"Lamba","year":"2019","journal-title":"World Neurosurg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1093\/neuonc\/noaa030","article-title":"Consensus recommendations for a standardized brain tumor imaging protocol for clinical trials in brain metastases","volume":"22","author":"Kaufmann","year":"2020","journal-title":"Neuro-oncology"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e270","DOI":"10.1016\/S1470-2045(15)70057-4","article-title":"Response assessment criteria for brain metastases: Proposal from the RANO group","volume":"16","author":"Lin","year":"2015","journal-title":"Lancet Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1613","DOI":"10.1093\/neuonc\/noac118","article-title":"Brain metastases: A Society for Neuro-Oncology (SNO) consensus review on current management and future directions","volume":"24","author":"Aizer","year":"2022","journal-title":"Neuro-oncology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1002\/cam4.1352","article-title":"The growing importance of lesion volume as a prognostic factor in patients with multiple brain metastases treated with stereotactic radiosurgery","volume":"7","author":"Routman","year":"2018","journal-title":"Cancer Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"vdac022","DOI":"10.1093\/noajnl\/vdac022","article-title":"Multiplicity does not significantly affect outcomes in brain metastasis patients treated with surgery","volume":"4","author":"Yang","year":"2022","journal-title":"Neuro-Oncol. Adv."},{"key":"ref_24","first-page":"103","article-title":"Factors associated with mortality after breast cancer metastasis","volume":"23","author":"Jung","year":"2012","journal-title":"Cancer Causes Control"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1132","DOI":"10.3171\/2014.9.JNS13939","article-title":"Impact of surgical methodology on the complication rate and functional outcome of patients with a single brain metastasis","volume":"122","author":"Patel","year":"2015","journal-title":"J. Neurosurg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1392","DOI":"10.1245\/s10434-016-5709-y","article-title":"Surgical Resection of Cerebral Metastases Leads to Faster Resolution of Peritumoral Edema than Stereotactic Radiosurgery: A Volumetric Analysis","volume":"24","author":"Shimony","year":"2017","journal-title":"Ann. Surg. Oncol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"280\u2013288, disucssion 288-289","DOI":"10.1016\/j.surneu.2007.12.019","article-title":"Combined surgical resection and stereotactic radiosurgery for treatment of cerebral metastases","volume":"71","author":"Limbrick","year":"2009","journal-title":"Surg. Neurol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1007\/s10585-012-9542-9","article-title":"Extent of peritumoral brain edema correlates with prognosis, tumoral growth pattern, HIF1a expression and angiogenic activity in patients with single brain metastases","volume":"30","author":"Spanberger","year":"2013","journal-title":"Clin. Exp. Metastasis"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"871","DOI":"10.21873\/anticanres.11392","article-title":"Correlation of Tumor and Peritumoral Edema Volumes with Survival in Patients with Cerebral Metastases","volume":"37","author":"Kerschbaumer","year":"2017","journal-title":"Anticancer Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.radonc.2021.11.010","article-title":"Radiomics outperforms semantic features for prediction of response to stereotactic radiosurgery in brain metastases","volume":"166","author":"Gutsche","year":"2022","journal-title":"Radiother. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1007\/s11060-009-0061-8","article-title":"The role of surgical resection in the management of newly diagnosed brain metastases: A systematic review and evidence-based clinical practice guideline","volume":"96","author":"Kalkanis","year":"2010","journal-title":"J. Neuro-Oncol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"181","DOI":"10.3171\/2009.11.JNS09659","article-title":"Factors influencing the risk of local recurrence after resection of a single brain metastasis","volume":"113","author":"Patel","year":"2010","journal-title":"J. Neurosurg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"730","DOI":"10.3171\/2008.8.JNS08448","article-title":"Reduced local recurrence of a single brain metastasis through microscopic total resection","volume":"110","author":"Yoo","year":"2009","journal-title":"J. Neurosurg."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Junger, S.T., Pennig, L., Schodel, P., Goldbrunner, R., Friker, L., Kocher, M., Proescholdt, M., and Grau, S. (2021). The Debatable Benefit of Gross-Total Resection of Brain Metastases in a Comprehensive Treatment Setting. Cancers, 13.","DOI":"10.3390\/cancers13061435"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/19\/3157\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T04:13:18Z","timestamp":1791605598000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/19\/3157"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,29]]},"references-count":34,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["cancers18193157"],"URL":"https:\/\/doi.org\/10.3390\/cancers18193157","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,29]]}}}