Effect of perioperative seizures on mortality and recurrence in patients with brain metastases

Yilong Zheng; Yuxiu Yang; Min Hui Ng; Adrienne Yu Hsiang Chew; Chun Peng Goh; Christopher Yuan Kit Chua; Rahul Rathakrishnan; Yvonne Ang; Andrea Li Ann Wong; Balamurugan Vellayappan; Kejia Teo; Vincent Diong Weng Nga; Tseng Tsai Yeo; Mervyn Jun Rui Lim

doi:10.3389/fonc.2022.1048304

Effect of perioperative seizures on mortality and recurrence in patients with brain metastases

Front Oncol. 2022 Nov 14:12:1048304. doi: 10.3389/fonc.2022.1048304. eCollection 2022.

Affiliations

¹ Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
² Division of Neurosurgery, National University Health System, Singapore, Singapore.
³ Division of Neurology, National University Health System, Singapore, Singapore.
⁴ Department of Hemotology-Oncology, National University Health System, Singapore, Singapore.
⁵ Department of Radiation Oncology, National University Health System, Singapore, Singapore.

Abstract

Objective: To identify the independent risk factors for 30-day perioperative seizures, as well as to evaluate the effect of perioperative seizures on overall mortality and tumor recurrence among patients who underwent surgical resection of brain metastases.

Methods: Patients who underwent surgical resection of brain metastases at our institution between 2011 and 2019 were included. 30-day perioperative seizures were defined as the presence of any preoperative or postoperative seizures diagnosed by a neurosurgeon or neurologist within 30 days of metastases resection. Independent risk factors for 30-day perioperative seizures were evaluated using multivariate logistic regression models. Kaplan-Meier plots and Cox regression models were constructed to evaluate the effects of 30-day perioperative seizures on overall mortality and tumor recurrence. Subgroup analyses were conducted for 30-day preoperative and 30-day postoperative seizures.

Results: A total of 158 patients were included in the analysis. The mean (SD) age was 59.3 (12.0) years, and 20 (12.7%) patients had 30-day perioperative seizures. The presence of 30-day preoperative seizures (OR=41.4; 95% CI=4.76, 924; p=0.002) was an independent risk factor for 30-day postoperative seizures. Multivariate Cox regression revealed that any 30-day perioperative seizure (HR=3.25; 95% CI=1.60, 6.62; p=0.001) was independently and significantly associated with overall mortality but not tumor recurrence (HR=1.95; 95% CI=0.78, 4.91; p=0.154).

Conclusions: Among patients with resected brain metastases, the presence of any 30-day perioperative seizure was independently associated with overall mortality. This suggests that 30-day perioperative seizures may be a prognostic marker of poor outcome. Further research evaluating this association as well as the effect of perioperative antiepileptic drugs in patients with resected brain metastases may be warranted.

Keywords: brain cancer; brain tumor; epilepsy; resection; survival.