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@ARTICLE{Hulsbergen:302168,
      author       = {A. F. C. Hulsbergen and F. Siddi and C. Cerecedo and F. C.
                      Robertson and Y.-T. Lo and V. Kavouridis and F. Ehret$^*$
                      and C. A. C. Jessurun and I. R. Tewarie and J. G. Phillips
                      and J. J. C. Verhoeff and T. R. Smith and M. Broekman},
      title        = {{I}mpact of {E}xtent of {R}esection on {S}urvival in
                      {B}rain {M}etastasis: {A}n {A}nalysis of 867 {P}atients.},
      journal      = {Neurosurgery},
      volume       = {98},
      number       = {1},
      issn         = {0148-396X},
      address      = {Alphen aan den Rijn},
      publisher    = {Wolters Kluwer},
      reportid     = {DKFZ-2025-01286},
      pages        = {127-134},
      year         = {2026},
      note         = {2026 Jan 1;98(1):127-134},
      abstract     = {The association between extent of resection (EOR) and
                      outcomes after brain metastasis (BM) surgery remains
                      unclear. The aim of this study was to examine the relation
                      between EOR and overall survival (OS)/intracranial
                      progression-free survival (IC-PFS) in this patient group.We
                      included patients who underwent BM resection and had
                      postoperative MRI <72 hours. Presence of any residual on MRI
                      was defined as subtotal resection (STR) as opposed to gross
                      total resection. Multivariable analyses were adjusted for
                      known confounders. Post hoc analysis explored the effect
                      size across different subgroups. A secondary outcome was the
                      occurrence of leptomeningeal disease (LMD).We included 867
                      patients; median age was 61 years (IQR 53-68), and median BM
                      diameter was 3.0 cm (IQR 2.2-3.9). Extracranial metastases
                      were present in 310 $(35.8\%)$ patients, and 365 $(42.1\%)$
                      received stereotactic radiosurgery (SRS) to the resection
                      cavity. No residual on MRI was present in 345 patients
                      $(39.9\%).$ In multivariable analysis, STR correlated with
                      decreased IC-PFS (hazard ratio [HR] 1.32, $95\%$ CI
                      1.13-1.55, P < .001) and OS (HR 1.28, $95\%$ CI 1.08-1.53, P
                      = .005) and a higher occurrence of LMD (odds ratio 1.74,
                      $95\%$ CI 1.10-2.76, P = .02). STR + SRS also correlated
                      with decreased IC-PFS compared with gross total resection
                      (HR 1.35, $95\%$ CI 1.02-1.66, P = .04). In subgroup
                      analysis, the strongest association between EOR and outcomes
                      was observed in large (>3 cm) BMs, supratentorial BMs, and
                      patients without extracranial disease. The use of cavity SRS
                      or the number of BMs had little impact on this
                      association.Residual tumor on postoperative MRI after BM
                      resection correlated with worse IC-PFS and OS after
                      adjusting for confounding variables. An increased prevalence
                      of LMD may be a possible mechanism through which these
                      patients experience worse outcomes.},
      keywords     = {Brain metastasis (Other) / Extent of resection (Other) /
                      Intracranial progression-free survival (Other) / Magnetic
                      resonance imaging (Other) / Neurosurgery (Other) / Overall
                      survival (Other)},
      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:40548745},
      doi          = {10.1227/neu.0000000000003544},
      url          = {https://inrepo02.dkfz.de/record/302168},
}