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@ARTICLE{Wasilewski:300348,
      author       = {D. Wasilewski$^*$ and T. Araceli and A. Rafaelian and M.
                      Demetz and B. Asey and T.-F. Ersoy and A. Dauth and A.
                      Neumeister and R. Peukert and P. Pöser and C. Krämer and
                      J. Bukatz and Z. Shaked and C. Jelgersma and A. Früh and R.
                      Xu and M. Misch and D. Capper$^*$ and F. Ehret$^*$ and N.
                      Frost and L. Bullinger$^*$ and U. Keilholz$^*$ and C. Senft
                      and L. Schmidt and H. Krenzlin and F. Ringel and A. Pohrt
                      and H. S. Meyer and J. Gempt and J. Kerschbaumer and C.
                      Freyschlag and C. Thomé and M. Simon and D. Dubinski and T.
                      Freiman and N. O. Schmidt and M. Proescholdt and P. Vajkoczy
                      and J. Onken$^*$},
      title        = {{P}ractice {V}ariation in {P}erioperative {D}examethasone
                      {U}se and {O}utcomes in {B}rain {M}etastasis {R}esection.},
      journal      = {JAMA network open},
      volume       = {8},
      number       = {4},
      issn         = {2574-3805},
      address      = {Chicago, Ill.},
      publisher    = {American Medical Association},
      reportid     = {DKFZ-2025-00782},
      pages        = {e254689},
      year         = {2025},
      abstract     = {Variations in perioperative dexamethasone dosing are common
                      in brain metastasis resection, but their impact on patient
                      outcomes remains unclear.To evaluate the association between
                      perioperative dexamethasone dosing and patient outcomes,
                      focusing on overall survival (OS) and progression-free
                      survival (PFS).This retrospective multicenter comparative
                      effectiveness study used data collected from January 2010 to
                      December 2023. Patients with symptomatic brain metastases
                      undergoing primary surgical resection at 7 neurological
                      centers in Germany and 1 in Austria and who had complete
                      records of perioperative dexamethasone dosing were included.
                      Propensity score matching (PSM) was used to control for
                      confounders. Analysis was conducted from March to June
                      2024.Cumulative perioperative dexamethasone administration
                      over 27 days, dichotomized at 122 mg using maximally
                      selected rank statistics.The primary outcome was OS.
                      Secondary outcomes included extracranial PFS (ecPFS) and
                      intracranial PFS (icPFS) as well as incidence of wound
                      revision surgery after brain metastasis resection. Hazard
                      ratios (HRs) were calculated using Cox proportional hazards
                      models.A total of 1064 patients were included in the
                      analysis. The median (IQR) age was 64 (56-72) years, with
                      489 female patients $(49\%)$ and 541 male patients $(51\%).$
                      Non-small cell lung cancer (NSCLC) was the most common tumor
                      entity (564 patients $[53\%]),$ followed by breast cancer
                      (146 patients $[14\%])$ and melanoma (138 patients
                      $[13\%]).$ After PSM, patients receiving cumulative
                      dexamethasone doses less than 122 mg had a median OS of 19.1
                      $(95\%$ CI, 15.2-22.4) months compared with 12.0 $(95\%$ CI,
                      9.1-14.7) months for those receiving 122 mg or more (P =
                      .002). Multivariable analysis showed an independent
                      association between higher cumulative dexamethasone doses
                      and reduced OS (HR, 1.40; $95\%$ CI, 1.18-1.66; P < .001).
                      Secondary analyses demonstrated consistent findings with
                      icPFS and ecPFS and a dose-response association between
                      cumulative dexamethasone and hazard for death.In this study,
                      higher cumulative perioperative dexamethasone was associated
                      with reduced OS, icPFS, and ecPFS in patients undergoing
                      brain metastasis resection. These findings suggest that
                      stricter dosing protocols could improve outcomes.
                      Prospective trials are warranted to confirm these
                      associations and guide evidence-based practice.},
      keywords     = {Humans / Dexamethasone: administration $\&$ dosage /
                      Dexamethasone: therapeutic use / Female / Male / Brain
                      Neoplasms: secondary / Brain Neoplasms: surgery / Brain
                      Neoplasms: drug therapy / Brain Neoplasms: mortality /
                      Middle Aged / Retrospective Studies / Aged / Germany /
                      Perioperative Care: methods / Austria / Propensity Score /
                      Treatment Outcome / Dexamethasone (NLM Chemicals)},
      cin          = {BE01},
      ddc          = {610},
      cid          = {I:(DE-He78)BE01-20160331},
      pnm          = {899 - ohne Topic (POF4-899)},
      pid          = {G:(DE-HGF)POF4-899},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:40214989},
      pmc          = {pmc:PMC11992604},
      doi          = {10.1001/jamanetworkopen.2025.4689},
      url          = {https://inrepo02.dkfz.de/record/300348},
}