Herr Sanjeev, Kite Trent, Vyas Praveer, Karlovits Stephen, Yu Alexander, Wegner Rodney E, Shepard Matthew J
Drexel University College of Medicine, Philadelphia, PA, USA.
Department of Neurosurgery, Allegheny Health Network Neuroscience Institute, Pittsburgh, PA, USA.
J Neurooncol. 2025 Feb;171(3):581-588. doi: 10.1007/s11060-024-04873-2. Epub 2024 Nov 14.
Meningiomas are the most frequent primary intracranial malignancy. While surgical resection can confer long term tumor control, stereotactic radiosurgery (SRS) is often used for small, asymptomatic tumors in the adjuvant setting. Frailty has been associated with increased rates of peri-operative morbidity but has yet to be defined in the setting of SRS for meningiomas. We therefore sought to examine the relationship between frailty and clinical/radiographic outcomes of patients with meningiomas who have undergone SRS.
A single-center, retrospective cohort study classified patients by their 5-factor modified frailty index (mFI-5) score into pre-frail (0-1) and frail (2-5) at the time of SRS treatment. Evaluations of overall survival (OS), progression free survival (PFS), local control (LC), and distant control (DC) were performed using Kaplan-Meier analysis. Cox proportional hazards regression analysis was used to further define factors associated with OS/PFS.
94 patients met inclusion criteria and underwent SRS for meningioma treatment from 2019 to 2023. Analyses compared prefrail (0-1) and frail (2-5) individuals. Kaplan-Meier analysis demonstrated a near significant association between frailty and OS (HR 3.66, 95% CI 0.49-26.8 p = 0.05) with 3-year OS rates of 75.4% in the pre-frail versus 36.6% in the frail group. However, a significant relationship was demonstrated between frailty and PFS (HR: 2.95 95% CI 1.12-7.81, p = 0.02) with 3-year PFS rates of 90.5% in the pre-frail group versus 49.2% in the frail group. Univariable regression analysis demonstrated that frailty, prior surgical excision, and cumulative tumor volume predicted PFS.
Frailty, as assessed by the mFI-5, did not independently predict OS but did predict PFS in individuals with meningioma undergoing SRS.
脑膜瘤是最常见的原发性颅内恶性肿瘤。虽然手术切除可实现长期肿瘤控制，但立体定向放射外科治疗（SRS）常用于辅助治疗小型无症状肿瘤。虚弱状态与围手术期发病率增加有关，但在脑膜瘤的SRS治疗中尚未明确。因此，我们试图研究虚弱状态与接受SRS治疗的脑膜瘤患者临床/影像学结果之间的关系。
一项单中心回顾性队列研究，在SRS治疗时，根据患者的5因素改良虚弱指数（mFI-5）评分将其分为脆弱前期（0-1）和虚弱期（2-5）。采用Kaplan-Meier分析评估总生存期（OS）、无进展生存期（PFS）、局部控制（LC）和远处控制（DC）。Cox比例风险回归分析用于进一步确定与OS/PFS相关的因素。
94例患者符合纳入标准，于2019年至2023年接受了脑膜瘤的SRS治疗。分析比较了脆弱前期（0-1）和虚弱期（2-5）个体。Kaplan-Meier分析显示，虚弱状态与OS之间存在接近显著的关联（HR 3.66，95%CI 0.49-26.8，p = 0.05），脆弱前期组3年OS率为75.4%，虚弱组为36.6%。然而，虚弱状态与PFS之间存在显著关系（HR：2.95，95%CI 1.12-7.81，p = 0.02），脆弱前期组3年PFS率为90.5%，虚弱组为49.2%。单变量回归分析表明，虚弱状态、既往手术切除和累积肿瘤体积可预测PFS。
通过mFI-5评估的虚弱状态并不能独立预测接受SRS治疗的脑膜瘤患者的OS，但可预测PFS。
