Rajkumar Sujay, Kite Trent, Desai Jay, Lucido Thomas, Mathieu David, Tripathi Manjul, Singh Navneet, Kumar Narendra, Mantziaris Georgios, Pikis Stylianos, Sheehan Jason P, 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 Clin Neurosci. 2025 Feb;132:110979. doi: 10.1016/j.jocn.2024.110979. Epub 2024 Dec 13.
Non-small cell lung cancer (NSCLC) patients often develop brain metastases (BMs), complicating management. We have shown that increasing frailty is associated with decreased overall survival (OS) and central nervous system progression free survival (PFS) for patients undergoing stereotactic radiosurgery (SRS) to BMs. Leveraging the International Radiosurgery Research Foundation, we sought to expand upon these findings, in NSCLC specifically.
Across four institutions, 193 patients with (≥1) NSCLC derived BMs with minimum 3 months of clinical/radiographic follow-up were analyzed. Primary outcomes included OS and PFS. Patients were stratified utilizing the mFI-5 into pre-frail (0-1), frail (2), and severely frail (3 + ).
Increased frailty was associated with diminished OS (frail hazard ratio (HR) = 2.49, 95 % CI [1.61-3.85]; severely frail HR = 2.65, 95 % CI [1.57-4.45]). The 6-month post-SRS survival rate was 86.1 %, 69.5 % and 54.5 % for pre-frail, frail and severely frail patients, respectively (p < 0.001). Frailty was not significantly predictive of time to PFS on multivariate Cox Proportional Hazards analysis although there was a trend towards diminished PFS with increasing frailty (median PFS was 18.4, 8.0, and 7.4 months for pre-frail, frail, and severely frail, respectively (p = 0.11). As age > 65 was also predictive of shorter OS (HR = 1.78, 95 % CI [1.23-2.56]). We generated a novel scoring system incorporating age and frailty status. The median survival of patients that scored 0, 1, 2, and 3 points were 21.1, 18.3, 8.9, and 5.6 months, respectively (p < 0.001). The area under the curve of the validation cohort using a logistic regression model was 0.77.
Our results indicate that the MFI-5 is a promising metric with application at the point of care to provide decision support for patients with NSCLC derived BMs.
非小细胞肺癌（NSCLC）患者常发生脑转移（BMs），使治疗变得复杂。我们已经表明，对于接受立体定向放射外科治疗（SRS）的BMs患者，虚弱程度增加与总生存期（OS）降低和中枢神经系统无进展生存期（PFS）降低相关。利用国际放射外科研究基金会，我们试图在NSCLC患者中进一步拓展这些发现。
在四个机构中，对193例患有（≥1个）NSCLC来源的BMs且有至少3个月临床/影像学随访的患者进行了分析。主要结局包括OS和PFS。利用改良虚弱指数-5（mFI-5）将患者分为虚弱前期（0-1分）、虚弱（2分）和严重虚弱（3分及以上）。
虚弱程度增加与OS降低相关（虚弱组风险比（HR）=2.49，95%置信区间[1.61-3.85]；严重虚弱组HR=2.65，95%置信区间[1.57-4.45]）。SRS后6个月的生存率，虚弱前期、虚弱和严重虚弱患者分别为86.1%、69.5%和54.5%（p<0.001）。在多变量Cox比例风险分析中，虚弱对PFS时间没有显著预测作用，尽管随着虚弱程度增加有PFS降低的趋势（虚弱前期、虚弱和严重虚弱患者的中位PFS分别为18.4、8.0和7.4个月（p=0.11）。由于年龄>65岁也可预测较短的OS（HR=1.78，95%置信区间[1.23-2.56]）。我们生成了一个包含年龄和虚弱状态的新评分系统。得0、1、2和3分患者的中位生存期分别为21.1、18.3、8.9和5.6个月（p<0.001）。使用逻辑回归模型的验证队列的曲线下面积为0.77。
我们的结果表明，mFI-5是一个有前景的指标，可在床边应用，为NSCLC来源的BMs患者提供决策支持。
