Chief, Neurosurgical Oncology Department of Neurosurgery, Yale School of Medicine New Haven, Connecticut, United States
Introduction: Frailty’s association with longitudinal outcomes and tumor characteristics in meningioma patients remains poorly understood. We sought to explore correlations between the modified frailty index (mFI), Karnofsky Performance Scale (KPS), and other outcomes.
Methods: The 11-point mFI was used to assess preoperative frailty summarized as aggregate frailty (AF) with neurological frailty (NF) and medical frailty (MF) subcomponents. mFI was categorized as non-frail, mild, and severe to assess impact (non-frail vs frail) and severity (mild vs severe). This was correlated with other retrospectively obtained variables.
Results: 323 intracranial meningiomas from 301 patients were included. Medically frail patients were older (pm < 0.001) and male (pm=0.004), with higher severity amongst males (pm=0.003). Frailty severity correlated with more aggressive tumor features, including higher WHO grade (pn=0.0012;pm=0.001), presence of edema (pn=0.001;pm=0.029), and elevated proliferative index (pn=0.016;pm=0.002). Interestingly, severe frailty was noted in patients with non-skull base tumors (pn=0.036;pm=0.001) and patients with NF had larger tumor volumes (pn < 0.001). Frail patients tended to have poor preoperative KPS (pn < 0.001;pm=0.035) and frailty severity was notable in NF patients (pn=0.029). Neurological frailty remained associated with poor postoperative KPS (pn < 0.001), however, those patients were able to improve in performance following surgery (pn=0.054). NF correlated with worse outcomes, including longer hospital stay (pn < 0.001), discharge to rehab (pn < 0.001), and mortality (pn=0.011). Frailty correlated with lower overall survival (OS) (pa < 0.0001;pn=0.008;pm < 0.001) and those with severe frailty were 5 times more likely to have shorter OS.
Conclusion : Frailty in meningioma patients is associated with poor KPS and more complicated courses with worse outcomes. Severity correlates with higher grade tumors and larger volumes and edema. Those patients whose frailty is driven by neurological issues tend to have more prolonged hospital courses and recovery but can demonstrate functional improvement with surgery. More detailed frailty assessments can lend important insights into postoperative performance status and survival.
