Cumulative incidence and survival outcomes of brain metastases in sarcoma: a large single center retrospective analysis.

Abstract

Background: The incidence and predictors of brain metastases (BrM) from sarcoma remain poorly characterized. We aimed to determine the cumulative incidence (CuI) and risk factors for BrM.

Methods: We retrospectively analyzed data from all sarcoma patients who presented to our center (2006-2023). CuI was calculated from initial presentation to BrM, stratified by key variables. Univariable (UVA) and multivariable competing risk regression analyses (MVA) were conducted to identify risk factors.

Results: Among 5110 sarcoma patients, 117 developed BrM. CuI rates were 1.8%, 2.4%, and 2.9% at 24, 48, and 72 months, respectively, within a median onset of 17 months. On UVA, intrathoracic primary site, alveolar soft part (ASPS), epithelioid, intimal and Rhabdomyosarcoma histologies, and stage IV at diagnosis were associated with increased CuI, while age ≥59, retroperitoneal origin and liposarcoma were associated with decreased CuI. On MVA the following remained correlated to BrM incidence: intrathoracic primary (HR 5.13), ASPS (HR 4.2), age ≥59 years (HR 0.45) and liposarcoma (HR 0.11); 44.3% presented with solitary BrM. Median survival post-BrM diagnosis was 6 months.

Conclusion: BrM risk in sarcoma varies by age, histology, and tumor location. Solitary metastases were common in our BrM cohort, and OS post-BrM was poor.