NOTQ-07 PREOPERATIVE NEUROLOGICAL IMPAIRMENT AND FUNCTIONAL STATUS IN INFILTRATIVE VERSUS NON-INFILTRATIVE BRAIN METASTASES: A COMPARATIVE STUDY
TL;DR
Infiltrative BM are associated with reduced presurgical functional status and a markedly higher frequency of hemiparesis, aphasia, and seizures, indicating an increased neurological burden prior to surgical treatment.
Abstract
Abstract Background Infiltrative growth patterns (HGPs) in brain metastases (BM) has been linked to greater neurological morbidity and poorer clinical outcomes. However, its quantitative effect on presurgical neurological deficits and functional status remains insufficiently characterized. Methods Following the previously established MetInfilt protocol, brain–tumor interface specimens were prospectively obtained and analyzed histologically in patients undergoing resection of one or more BM between June 2019 and September 2025. Infiltrative growth was assessed on H&E- and IHC-stained interface sections. A cohort of 50 patients was matched for sex, age, metastatic status and timing, primary tumor type, and lesion location. Presurgical functional status was evaluated using the Karnofsky Performance Status (KPS). Neurological deficits included hemiparesis, visual field impairment, aphasia, and seizures. Differences in KPS were analyzed using a two-sample t-test assuming equal variances, while categorical variables were compared using Pearson’s chi-square test. Results Infiltrative BM were identified in 76.3% of patients. Those without infiltrative tumors demonstrated a higher median presurgical KPS (90, range 50–100) compared with patients exhibiting infiltrative growth (80, range 40–90). The mean difference in KPS was 9.35 points (t = 1.70, p = 0.038). Hemiparesis was observed in 11.1% of patients without infiltration versus 51.7% with infiltration (p = 0.042). Aphasia occurred in 11.1% of non-infiltrative cases compared with 51.7% in infiltrative cases (p = 0.024). Seizures were reported in 11.1% of non-infiltrative tumors and 48.3% of infiltrative tumors (p = 0.033). No significant difference was found for visual field deficits (p = 0.405). Conclusions Infiltrative BM are associated with reduced presurgical functional status and a markedly higher frequency of hemiparesis, aphasia, and seizures, indicating an increased neurological burden prior to surgical treatment.