Torres-Perez Patricia, Álvarez-Satta María, Arrazola Mariano, Egaña Larraitz, Moreno-Valladares Manuel, Villanua Jorge, Ruiz Irune, Sampron Nicolas, Matheu Ander
Osakidetza Basque Health Service, Donostia University Hospital San Sebastián, Spain.
Group of Cellular Oncology, Biodonostia Health Research Institute San Sebastián, Spain.
Am J Cancer Res. 2021 Jun 15;11(6):3294-3303. eCollection 2021.
Frailty represents a state of vulnerability that increases the risk of adverse health outcomes. In the last years, frailty has emerged as a good indicator of patient's functional reserve and it seems to be a predictor of negative outcomes in oncological patients. In this work, we analyzed the clinical utility of frailty as preoperative risk assessment tool in a brain tumor cohort from Donostia University Hospital (Spain). For that, we used several frailty tools consisting of questionnaires based on frailty phenotype (FRAIL scale), evaluating functional performance (Gait Speed) and a self-report questionnaire that includes variables related to the physical, cognitive and psychosocial domains of frailty (Tilburg Frailty Indicator). We identified a higher percentage of patients in vulnerable situation prior to surgery when using frailty tools compared to routine scales such as Karnosfky score and Barthel Index. Remarkably, patients diagnosed with malignant tumors were frailer and presented significant less six-month survival than patients with benign tumors by all the frailty scales abovementioned. In line with this, the vast majority of patients that became pre-frail or frail after neurosurgery (by FRAIL scale) harbored a malignant tumor. Moreover, frailty status significantly correlated with patient's mortality and autonomy, but not with the presence of postoperative outcomes in our cohort. Taken together, our results show that frailty measurement, mainly by FRAIL scale, is a useful tool to evaluate preoperative risk in brain tumor patients as well as patient's prognosis after neurosurgery.
衰弱代表一种脆弱状态，会增加不良健康结局的风险。在过去几年中，衰弱已成为患者功能储备的良好指标，并且似乎是肿瘤患者不良结局的预测指标。在这项研究中，我们分析了衰弱作为术前风险评估工具在西班牙多诺斯提亚大学医院脑肿瘤队列中的临床效用。为此，我们使用了几种衰弱评估工具，包括基于衰弱表型的问卷（FRAIL量表）、评估功能表现的工具（步速）以及一份包含与衰弱的身体、认知和社会心理领域相关变量的自我报告问卷（蒂尔堡衰弱指标）。与卡诺夫斯基评分和巴氏指数等常规量表相比，我们发现使用衰弱评估工具时，术前处于脆弱状态的患者比例更高。值得注意的是，通过上述所有衰弱量表评估，被诊断为恶性肿瘤的患者比良性肿瘤患者更衰弱，且六个月生存率显著更低。与此一致的是，神经外科手术后变为衰弱前期或衰弱的患者（通过FRAIL量表评估）绝大多数患有恶性肿瘤。此外，衰弱状态与患者的死亡率和自主性显著相关，但与我们队列中的术后结局无关。综上所述，我们的结果表明，主要通过FRAIL量表进行的衰弱测量是评估脑肿瘤患者术前风险以及神经外科手术后患者预后的有用工具。
