• Alexander F C Hulsbergen, Yu Tung Lo, Ilia Awakimjan, Vasileios K Kavouridis, John G Phillips, Timothy R Smith, Joost J C Verhoeff, Kun-Hsing Yu, BroekmanMarike L DMLDDepartments of Neurosurgery, Haaglanden Medical Center and Leiden University Medical Center, Leiden University, Leiden, The Netherlands.Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA., and Omar Arnaout.
• Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
• Neurosurgery. 2022 Sep 1; 91 (3): 381388381-388.

BackgroundCurrent prognostic models for brain metastases (BMs) have been constructed and validated almost entirely with data from patients receiving up-front radiotherapy, leaving uncertainty about surgical patients.ObjectiveTo build and validate a model predicting 6-month survival after BM resection using different machine learning algorithms.MethodsAn institutional database of 1062 patients who underwent resection for BM was split into an 80:20 training and testing set. Seven different machine learning algorithms were trained and assessed for performance; an established prognostic model for patients with BM undergoing radiotherapy, the diagnosis-specific graded prognostic assessment, was also evaluated. Model performance was assessed using area under the curve (AUC) and calibration.ResultsThe logistic regression showed the best performance with an AUC of 0.71 in the hold-out test set, a calibration slope of 0.76, and a calibration intercept of 0.03. The diagnosis-specific graded prognostic assessment had an AUC of 0.66. Patients were stratified into regular-risk, high-risk and very high-risk groups for death at 6 months; these strata strongly predicted both 6-month and longitudinal overall survival ( P < .0005). The model was implemented into a web application that can be accessed through http://brainmets.morethanml.com .ConclusionWe developed and internally validated a prediction model that accurately predicts 6-month survival after neurosurgical resection for BM and allows for meaningful risk stratification. Future efforts should focus on external validation of our model.Copyright © Congress of Neurological Surgeons 2022. All rights reserved.

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