The 5-factor modified frailty index as a prognostic factor following stereotactic radiosurgery for metastatic disease to the brain from non-small cell lung cancer: A multi-center cohort analysis.

Autor: Rajkumar S; Drexel University College of Medicine, Philadelphia, PA, USA., Kite T; Department of Neurosurgery, Allegheny Health Network Neuroscience Institute, Pittsburgh, PA, USA., Desai J; Drexel University College of Medicine, Philadelphia, PA, USA., Lucido T; Drexel University College of Medicine, Philadelphia, PA, USA., Mathieu D; Université de Sherbrooke, Centre de recherche du CHUS, Canada., Tripathi M; Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India., Singh N; Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India., Kumar N; Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India., Mantziaris G; Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA., Pikis S; Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA., Sheehan JP; Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA., Wegner RE; Drexel University College of Medicine, Philadelphia, PA, USA; Division of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA., Shepard MJ; Drexel University College of Medicine, Philadelphia, PA, USA; Department of Neurosurgery, Allegheny Health Network Neuroscience Institute, Pittsburgh, PA, USA. Electronic address: matthew.shepard@ahn.org.
Jazyk: angličtina
Zdroj: Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia [J Clin Neurosci] 2024 Dec 13; Vol. 132, pp. 110979. Date of Electronic Publication: 2024 Dec 13.
DOI: 10.1016/j.jocn.2024.110979
Abstrakt: Background: 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.
Methods: 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 + ).
Results: 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.
Conclusions: 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.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024. Published by Elsevier Ltd.)
Databáze: MEDLINE
Externí odkaz: