Baseline Graded Prognostic Assessment Is Associated with Postoperative Health-Related Quality of Life Recovery After Brain Metastasis Resection: A Prospective Cohort Study

Objective: The objective was to evaluate longitudinal changes in health-related quality of life (HRQoL) following surgical resection of brain metastases and investigate the prognostic value of the Graded Prognostic Assessment (GPA) score in predicting HRQoL improvement. Methods: This prospective observational study included 42 consecutive adult patients undergoing microsurgical resection for histopathologically confirmed brain metastases. HRQoL was assessed using the EuroQol Five-Dimension Five-Level questionnaire (EQ-5D-5L) questionnaire and EuroQol Visual Analogue Scale (EQ-VAS) preoperatively and at 1 and 6 months postoperatively. Patients were stratified according to their preoperative GPA scores, and longitudinal changes in HRQoL were analyzed using non-parametric statistical methods. Results: Mean EQ-VAS scores exhibited a significant postoperative increase from 38.3 ± 19.3 at baseline to 77.6 ± 19.3 at one month and 75.7 ± 16.7 at six months (p < 0.001). Significant improvements were observed across all five EQ-5D-5L dimensions (all p < 0.001). Patients with favorable GPA scores (3.0–4.0) demonstrated greater improvements in EQ-VAS than those in lower GPA categories at one month (p = 0.035) and six months (p = 0.013). Higher baseline GPA scores were positively correlated with HRQoL improvement at both follow-up time points (ρ = 0.51 and ρ = 0.50, respectively; both p < 0.001). Changes in clinician-rated Karnofsky Performance Status (KPS) did not differ significantly across GPA categories (p = 0.731). Conclusions: Surgical resection of brain metastases significantly improves patient-reported HRQoL. The GPA score is a significant predictor of postoperative HRQoL gain, whereas traditional clinician-rated scales like KPS may lack the sensitivity to capture these patient-centered improvements. However, the findings regarding GPA subgroups should be considered exploratory due to the limited number of patients in certain tiers.