神经外科手术切除是肺癌脑转移（BMs）的标准局部治疗。本研究旨在调查神经外科手术切除是否对KPS较差的肺癌BMs患者提供生存利益。这个多中心回顾性研究包括3个医疗机构2010年8月至2021年7月间共治疗1177例肺癌BMs患者中，386例术前KPS≤70的患者。数据分析从2022年7月到9月进行。使用处理倾向评分的反向治疗概率加权（IPTW）和匹配分析（PSM）来最小化偏差。主要结果为BMs诊断后的总生存期（OS）。使用Cox比例风险回归模型估计OS的风险因素。所有特征都包括在多元Cox回归中。包括术前KPS≤70的386例患者（年龄平均值[SD]为57.85 [10.36]岁；KPS平均值[SD]为60.91 [10.11]）。其中111名患者接受了神经外科手术切除，而275名患者没有接受。经过IPTW或PSM后，基线特征在各组之间平衡。在未经调整的多元Cox分析（风险比[HR]：0.68，95%置信区间[CI]：0.51-0.91，P =0.01）、PSM调整后的多元Cox分析（HR：0.61，95%CI：0.39-0.94，P =0.03）、IPTW调整后的多元Cox分析（HR：0.58，95%CI：0.40-0.84，P =0.004）中，神经外科手术切除与显著更好的预后相关联。根据未经调整的数据（手术与非手术的中位OS，14.7与12.5个月，P =0.01）、经PSM调整的数据（手术与非手术的中位OS，17.7与12.3个月，P <0.01）和经IPTW调整的数据（手术与非手术的中位OS，17.7与12.5个月，P <0.01），神经外科手术切除组的OS显著比非手术切除组更长。神经外科手术切除与肺癌BMs患者KPS较差的生存有关，提示KPS较差不是这些患者进行神经外科手术切除的禁忌症。©2023. 作者。

Neurosurgical resection is a standard local treatment for lung cancer brain metastases (BMs). This study aims to investigate whether neurosurgical resection provides survival benefit in lung cancer BMs with poor KPS.This multicenter retrospective study included 386 lung cancer BMs with pretreatment KPS ≤ 70 among a total of 1177 lung cancer BMs treated at three centers from August 2010 to July 2021. Data analysis was performed from July to September 2022. Inverse probability of treatment weighting (IPTW) and propensity scores matching (PSM) based on propensity scoring were used to minimize bias. The main outcome was overall survival (OS) after diagnosis of BMs. Risk factors of OS were estimated using Cox proportional hazards regression models. All Characteristics were included in the multivariate Cox regression.386 patients with pretreatment KPS ≤ 70 were included (age mean [SD], 57.85 [10.36] years; KPS mean [SD], 60.91 [10.11]). Among them, 111 patients received neurosurgical resection, while 275 patients did not. Baseline characteristics were balanced between groups after IPTW or PSM. Neurosurgical resection was associated with significantly better prognosis in unadjusted multivariate COX analysis (hazard ratio [HR]: 0.68, 95% confidence interval [CI]: 0.51-0.91, P = 0.01), and PSM-adjusted multivariate COX analysis (HR: 0.61, 95%CI: 0.39-0.94, P = 0.03), IPTW-adjusted multivariate COX analysis (HR: 0.58, 95%CI: 0.40-0.84, P = 0.004). OS was significantly longer in neurosurgical resection group compared with non-surgical resection group according to unadjusted data (Median OS, surgery vs non-surgery, 14.7 vs 12.5 months, P = 0.01), PSM-adjusted data (median OS, 17.7 vs 12.3 months, P < 0.01) and IPTW-adjusted data (median OS, 17.7 vs 12.5 months, P < 0.01).Neurosurgical resection was associated with improved survival in patients with lung cancer BMs with poor KPS, suggesting that poor KPS is not a contraindication for neurosurgical resection in these patients.© 2023. The Author(s).