P27.09.B EXPLORING THE IMPACT OF FRAILTY SCORES ON GLIOBLASTOMA TREATMENT: A RETROSPECTIVE MULTICENTER STUDY
Authors: Caffo M , Conte L , Ius T , Sabatino G , Di Stefano A L , Gaviani P , Caruso G , Bruno F , Lombardi G , Santonocito O , Caliri S , Villanacci F , Somma T , De Nunzio G , Cascio D , Olivi A , Angileri F F , Rudà R , Silvani A 
Published: October 2024

Abstract

BACKGROUND
Defined by a reduced physiological resilience and an increased vulnerability to stressors, frailty is associated with aging and an higher probability of sickness and mortality risk. Influence of frailty on adverse outcomes and survival following craniotomy for glioblastoma is not well documented. Identifying risk factors for complications or mortality during and after surgical interventions is essential for refining surgical strategies and optimizing subsequent treatments.

MATERIAL AND METHODS
A retrospective multicenter evaluation was conducted involving 856 glioblastoma patients who had surgery between October 2013 and May 2023. Frailty levels were assessed using a standardized frailty index including variables, diabetes, chronic obstructive pulmonary disease, congestive heart failure, hypertension, neurological deficits post-stroke, renal insufficiency, antiplatelet drug, liver conditions, and presence of other tumors. Patients were classified as non-frail (score ≤2) or moderately to severely frail (score ≥3). We utilized Kaplan-Meier survival analysis and multivariable Cox proportional hazard models, adjusting for factors such as age, hospital stay, tumor volume, Karnofsky Performance Status (KPS) scores before and after surgery, Ki-67 index, and American Society of Anesthesiologists (ASA) score.

RESULTS: F
ollow-up ranges from 3 to 118 months, median age of participants was 64 years (SD: 10.94). Out of the cohort, 86.2% (738 patients) were non-frail, while 13.8% (118 patients) were classified as moderately to severely frail. Significant distinctions were noted between the groups in terms of pre- and post-operative KPS, age at diagnosis, and ASA score. The Cox regression analysis did not show a significant relationship between survival and variables such as age, frailty, both pre- and post-operative KPS, duration of hospital stay, pre- and post-operative tumor volume, and ASA score. Interestingly, patients with methylated promoter for the MGMT, significantly showed a later age at diagnosis compared to those who were non-mutated (mean 65 years old vs 63, p=0.02).

CONCLUSION
Although frail patients can show lower functional status, their potential for change post-op is similar to non-frail individuals. Our multivariate analyses indicate that frailty scores do not directly influence survival or KPS. These findings shows importance of new patient assessment. Enhancing management protocols for frail both pre-and post-op evaluating long-term effects of surgery are crucial. Future research should aim to develop an improved frailty index that better predicts mortality and morbidity following surgery. Considering variables such as age at diagnosis, which is correlated with methylation of MGMT promoter, we can define subgroup of patients correlated to complications related to surgery, or to findings of tumor or longer or less survival.