Factores pronósticos de mortalidad a un año en pacientes con diagnóstico de metástasis de fosa posterior atendidos en el Hospital Universitario Mayor entre 2013 y 2020
Thesis
Metastases in the central nervous system are a frequent presentation of systemic tumors and historically their presence indicates an unfavorable prognosis. Treatment is based on surgical resection and radiation, which have a positive impact on overall survival. Additionally, from advances in early diagnosis, a better survival time has been achieved. However, despite this, the vital prognosis of this pathology continues to be bleak. The determination of the prognosis has had great advances given the analysis of multiple databases of patients with brain metastases. From 1997 to recent years, several tools have been developed that seek to identify variables that determine overall survival in patients with brain metastases. The first one, the RPA and later SIR, BSBM and finally the GPA. In general, these tools include common factors such as age and the Karnofsky Functionality Scale (KPS), but differ in some others such as the number of brain metastases or the control of extracranial disease. Even molecular advances in the diagnosis of cancer with their respective prognostic differences have made it necessary to include novel molecular variations of breast and lung carcinoma in the GPA. Posterior fossa metastases make up 20% of brain metastases, and their location has also been associated with a poor prognosis. Additionally, many of them are related to compression of brain stem structures and hydrocephalus that even determine a worse prognosis in this group of patients. Unfortunately, no specific tools have been developed to determine prognosis in patients with posterior fossa metastases. For this reason, it is important to determine those prognostic factors for mortality at one year in patients with posterior fossa metastases. OBJECTIVE: To evaluate the prognostic factors for mortality in adult patients with posterior fossa metastases evaluated at a university hospital in the city of Bogotá during the period between 2013 and 2020. METHODOLOGY: Cohort analytical study. The patients treated by the neurosurgery service of the Hospital Universitario Mayor-Méderi during the years 2013 to 2020 were studied. The cohorts that were compared were made up of patients with posterior fossa metastases treated at the institution during the study period, classified into exposed and unexposed, according to the severity estimated at admission by the RPA and GPA scales under study (RPA group III and GPA less than or equal to 1 vs. GPA greater than 1) and the outcome that was evaluated is mortality at 1 year. Descriptive statistical analyzes of the population were carried out, subsequently the factors associated with the risk of mortality at 1 year were analyzed and survival was determined through the Cox regression model. EXPECTED RESULTS: The aim was to study and identify prognostic factors in patients with posterior fossa metastases. This allowed an analysis to determine the therapeutic options in an individualized way when evaluating a patient with this type of pathology.
