Artikel
Key prognostic factors and the influence of frailty on overall survival in patients with brain metastasis
Schlüsselfaktoren und der Einfluss von frailty auf das Gesamtüberleben bei Patienten mit Hirnmetastasen
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Veröffentlicht: | 25. Mai 2022 |
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Gliederung
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Objective: Increasing numbers of brain metastases are noted due to better systemic treatment and therefore prolonged survival. Additionally, neurosurgery is facing a rising number of rather old patients with certain pre-disease conditions harboring brain metastases. Even if radiotherapy is commonly used for metastases in older patients, surgical resection is undoubtedly useful in certain patients. To identify patients amenable for surgery we retrospectively compared the integrative impact of frailty and other known factors in the context of overall survival.
Methods: Consecutive patients with resected brain metastases between 2005 and 2019 were included. Clinical, radiological and epidemiological data was analysed retrospectively, Clinical Frailty Score (CFS) was assessed from patient charts preoperative and at 3-6 months follow-up.
Results: 205 patients (110 male and 95 female) with a mean age of 60 years (SD ±12, range 11-84) were included. Each point of preoperative Clinical Frailty Score (CFS) increased hazards to decease during our FU for 21% (HR 1.210/point, CI95% 1.064-1.376; p=0.004), 10 years of age for 30% (HR 1.030/year, CI95% 1.015-1.047; p<0.001) and male gender correspondingly for 60% (HR 1.599, CI95% 1.233-2.232; p=0.007). Additionally, multiple BM (HR 1.155/each, CI95% 1.001-1.331; p=0.048) and preoperative tumor volume (HR 1.011/cc, CI95% 1.003-1.09; p=0.009) showed a significant negative impact on OS.
Very fit to patients with very mild frailty (0-4) had longer estimated mean OS of 34.6 months (26.7-42.6) compared to 15.2 months (6.4-23.9) in case of frailty (5-8) patients (p=0.011). Patients older than 65 years showed lower estimated mean OS of 22.3 months (13.5-31.2) in relation to younger ones with 38.2 months (28.4-48.0; p=0.011). Estimated mean OS was longer for females compared to males, 43.1 months (31.4-54.9) vs 22.4 months (14.9-30.0) correspondingly (p=0.004). Estimated mean OS was 36.3 months (26.9-45.6) if preoperative tumor volume remained 15cc (p=0.013). 34.1 months (25.4-42.9) OS for singular and 26.2 months (15.3-37.1) for multiple BM (p – n.s.) was found.
Conclusion: This analysis underlines the importance of patient selection, when considering surgery for brain metastases. Even if older patients are frequently withheld from more aggressive surgical treatment, preoperative status seemed less important for OS as compared to the clinical development during recovery (FU 3-6months).