Independent Prognostic Factors of Survival in Elderly Patients Undergoing Surgery for Non-small Cell Lung Cancer Brain Metastases: Assessing Surgical Eligibility

BACKGROUND AND OBJECTIVES: Brain metastases (BM) from non-small cell lung cancer (NSCLC) have a dismal prognosis, especially in elderly patients. We aimed to evaluate and identify factors influencing survival in these patients to determine suitability for, and expectations after resection. METHODS: Data of patients aged 70 years and older, operated for BM from NSCLC in our department between 2011 and 2020 were retrospectively studied. A Cox proportional hazards model was used to identify independent prognostic factors, and overall survival was evaluated using a Kaplan-Meier survival analysis. RESULTS: A total of 79 patients (50 men) with a mean age of 75 years met the inclusion criteria. Of those, 28% died within 3 months after surgery and 15% were long-term survivors (>24 months). Median survival from time of operation was 5.8 months. Infratentorial location of BM, operation in the posterior fossa, postoperative complications, and more BM were identified as negative predictors of survival whereas primary tumor surgery, postoperative brain radiation, and postoperative targeted therapy were independent positive prognostic factors. Comorbidities did not seem to impact survival. CONCLUSION: Geriatric patients with BM from NSCLC present a more dismal prognosis. This fragile population requires special care, especially perioperatively. Nevertheless, they should be regarded as eligible candidates for every available therapeutical modality, including surgery. Our data could help in decision-making and patient counseling.