Medical Student Yong Loo Lin School of Medicine, National University of Singapore
Introduction: Among patients with brain metastases, both frailty and sarcopenia have been shown to be associated with outcomes. However, their effects within the same cohort have thus far not been directly compared.
Methods: Patients who underwent surgical resection of brain metastases at our institution between 2011 and 2019 were included. The exclusion criteria were (1) presence of concomitant spinal metastases, (2) inadequate documentation for the assessment of frailty within 2 weeks prior to surgical resection, and/or (3) no CTTAP or MRI images that included the L3/4 spinal level within 200 days prior to surgical resection. The exposures were preoperative frailty as quantified using the Clinical Frailty Scale (CFS), and sarcopenia as quantified using the average cross-sectional areas of the psoas and temporalis muscles. For analyses regarding frailty, patients were grouped into frail (CFS>4) and not frail. For analyses regarding sarcopenia, patients were grouped into 3 gender-specific tertiles. The outcomes were overall mortality and duration of hospitalization.
Results: A total of 137 patients were included in the analysis. On multivariate analysis adjusting for potential confounders (extent of intracranial and extracranial disease, primary cancer site, demographics), both frailty and sarcopenia (psoas) were found to be significantly associated with overall mortality. However, the statistical significance was greater for frailty (frail group: HR 7.68; 95% CI 2.66, 22.1; p< 0.001) than for psoas cross-sectional area (highest tertile: HR 0.35; 95% CI 0.14, 0.86; p=0.023). Sarcopenia as defined using temporalis cross-sectional area was not significantly associated with overall mortality. Frailty and sarcopenia were not significantly associated with the duration of hospitalization.
Conclusion : Frailty was superior to sarcopenia for the prediction of overall mortality. Future research should examine whether the reduction of preoperative frailty via prehabilitation reduces mortality risk among patients undergoing surgical resection of brain metastases.
