1Drexel University College of Medicine, Philadelphia.
2Department of Neurosurgery, Allegheny Health Network Neuroscience Institute, Pittsburgh; and.
J Neurosurg. 2023 Oct 13;140(4):929-937. doi: 10.3171/2023.7.JNS231214. Print 2024 Apr 1.
Frailty, a state of increased vulnerability to adverse health outcomes, is associated with poor neurosurgical outcomes. The relationship between frailty and stereotactic radiosurgery (SRS) for brain metastases (BMs), however, has not been adequately described. In this study, the authors attempted to examine the connection between frailty and outcomes for patients receiving SRS for BMs.
A single-center retrospective cohort study was performed. The 5-factor modified frailty index (mFI-5) was used to stratify patients into pre-frail (mFI-5 score 0-1), frail (mFI-5 score 2), and severely frail (mFI-5 score ≥ 3) cohorts at the time of SRS treatment. Both overall survival (OS) and progression-free survival (PFS) were evaluated. Factors associated with OS/PFS were assessed using Kaplan-Meier analysis and a Cox proportional hazards model.
Two hundred three patients met the inclusion criteria and received SRS to one or more BMs. Fifty-six patients (27.6%) received SRS as an adjuvant treatment. The 12-month OS and PFS rates were 58.6% and 45.5%, respectively. One hundred twenty-six patients (62.1%) were classified as pre-frail, 58 (28.6%) as frail, and 19 (9.4%) as severely frail. Significantly less OS was demonstrated in frailer groups (frail hazard ratio [HR] 3.14, p < 0.005; severely frail HR 3.13, p < 0.005). Compared with pre-frail patients, frail patients had shorter intervals of PFS (frail HR 2.05, p < 0.005). Five patients (2.5%) had symptomatic radiation necrosis (RN) and 60 (29.6%) required repeat radiation.
Higher frailty scores at the time of SRS treatment were predictive of shorter OS and PFS intervals.
衰弱是对不良健康结果易感性增加的一种状态，与不良神经外科结果相关。然而，衰弱与脑转移瘤（BM）立体定向放射外科（SRS）之间的关系尚未得到充分描述。在这项研究中，作者试图检查接受 SRS 治疗 BM 的患者衰弱与结局之间的关系。
进行了一项单中心回顾性队列研究。使用五因素改良衰弱指数（mFI-5）将患者分层为 SRS 治疗时处于虚弱前期（mFI-5 评分 0-1）、虚弱（mFI-5 评分 2）和严重虚弱（mFI-5 评分≥3）队列。评估总生存期（OS）和无进展生存期（PFS）。使用 Kaplan-Meier 分析和 Cox 比例风险模型评估与 OS/PFS 相关的因素。
203 名患者符合纳入标准并接受了 SRS 治疗一个或多个 BM。56 名患者（27.6%）接受 SRS 作为辅助治疗。12 个月 OS 和 PFS 率分别为 58.6%和 45.5%。126 名患者（62.1%）被归类为虚弱前期，58 名（28.6%）为虚弱，19 名（9.4%）为严重虚弱。脆弱组的 OS 明显较低（脆弱 HR 3.14，p<0.005；严重脆弱 HR 3.13，p<0.005）。与虚弱前期患者相比，虚弱患者的 PFS 间隔更短（虚弱 HR 2.05，p<0.005）。有 5 名患者（2.5%）出现症状性放射性坏死（RN），60 名患者（29.6%）需要重复放疗。
SRS 治疗时较高的虚弱评分预测 OS 和 PFS 间隔较短。
