1Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, New Mexico.
2Department of Occupational Medicine, Loma Linda University Medical Center, Los Angeles, California; and.
Neurosurg Focus. 2023 Aug;55(2):E8. doi: 10.3171/2023.5.FOCUS23198.
Surgery plays a key role in the management of brain metastases. Stratifying surgical risk and individualizing treatment will help optimize outcomes because there is clinical equipoise between radiation and resection as treatment options for many patients. Here, the authors used a multicenter database to assess the prognostic utility of baseline frailty, calculated with the Risk Analysis Index (RAI), for prediction of mortality within 30 days after surgery for brain metastasis.
The authors pooled patients who had been surgically treated for brain metastasis from the American College of Surgeons National Surgical Quality Improvement Program database (2012-2020). The authors studied the relationship between preoperative calculated RAI score and 30-day mortality after surgery for brain metastasis by using linear-by-linear proportional trend tests and binary logistic regression. The authors calculated C-statistics (with 95% CIs) in receiver operating characteristic (ROC) curve analysis to assess discriminative accuracy.
The authors identified 11,038 patients who underwent brain metastasis resection with a median (interquartile range) age of 62 (54-69) years. The authors categorized patients into four groups on the basis of RAI: robust (RAI 0-20), 8.1% of patients; normal (RAI 21-30), 9.2%; frail (RAI 31-40), 75%; and severely frail (RAI ≥ 41), 8.1%. The authors found a positive correlation between 30-day mortality and frailty. RAI demonstrated superior predictive discrimination for 30-day mortality as compared with the 5-factor modified frailty index (mFI-5) on ROC analysis (C-statistic 0.65, 95% CI 0.65-0.66).
The RAI frailty score accurately estimates 30-day mortality after brain metastasis resection and can be calculated online with an open-access software tool: https://nsgyfrailtyoutcomeslab.shinyapps.io/BrainMetsResection/. Accordingly, RAI can be utilized to measure surgical risk, guide treatment options, and optimize outcomes for patients with brain metastases. RAI has superior discrimination for predicting 30-day mortality compared with mFI-5.
手术在脑转移的治疗中起着关键作用。对手术风险进行分层并进行个体化治疗，将有助于优化治疗效果，因为对于许多患者来说，放疗和切除术作为治疗选择之间存在临床平衡。在这里，作者使用多中心数据库评估基线脆弱性的预后实用程序，该脆弱性通过风险分析指数（RAI）计算，用于预测脑转移手术后 30 天内的死亡率。
作者从美国外科医师学院国家外科质量改进计划数据库（2012-2020 年）中汇集了接受脑转移手术治疗的患者。作者通过线性-线性比例趋势检验和二项逻辑回归研究了术前计算的 RAI 评分与脑转移手术后 30 天死亡率之间的关系。作者在接收者操作特征（ROC）曲线分析中计算了 C 统计量（95%CI），以评估判别准确性。
作者确定了 11038 例接受脑转移切除术的患者，中位（四分位距）年龄为 62（54-69）岁。作者根据 RAI 将患者分为四组：健壮（RAI 0-20），占 8.1%；正常（RAI 21-30），占 9.2%；脆弱（RAI 31-40），占 75%；严重脆弱（RAI≥41），占 8.1%。作者发现 30 天死亡率与脆弱性之间存在正相关。RAI 在 ROC 分析中对 30 天死亡率的预测判别优于 5 项修正脆弱指数（mFI-5）（C 统计量 0.65，95%CI 0.65-0.66）。
RAI 脆弱评分准确估计脑转移切除术后 30 天死亡率，并且可以使用在线开放访问软件工具进行计算：https://nsgyfrailtyoutcomeslab.shinyapps.io/BrainMetsResection/。因此，RAI 可用于衡量手术风险，指导治疗选择，并优化脑转移患者的治疗效果。RAI 对预测 30 天死亡率的判别优于 mFI-5。
