P11.55.B ROLE OF FRAILTY IN THE MANAGEMENT OF PATIENTS WITH GLIOBLASTOMA: A RETROSPECTIVE MULTICENTER STUDY
Authors: Caffo M , Mondello S , Ius T , Bruno F , Sabatino G , Di Stefano A L , Santonocito O , Caruso G , Curcio A , Vallone R , Caliri S , Cardali S M , Germanò A F , Olivi A , Angileri F F , Rudà R 
Published: September 2023

Abstract

BACKGROUND
Frailty is a state characterized by reduced physiological reserve and loss of resistance to stressors caused by accumulated age-related deficits. It has been associated with increased morbidity and is a strong predictor of mortality. Few data show the relationship of frailty with adverse outcomes and survival after elective craniotomy. Identification of risk factors that distinguish surgical candidates at elevated risk of peri-operative morbidity or mortality is imperative for informed surgical decision-making and post-operative radio and chemotherapy.

MATERIAL AND METHODS
This multicenter ongoing study is an analysis of a retrospective cohort, including 800 patients. We have currently analyzed the correlations in 364 patients underwent elective craniotomy for glioblastoma between July 2015 and October 2019. Frailty was assessed using validated scale, defined by the frailty index constructed according to the standard methodology, that includes age, diabetes, functional status, chronic obstructive pulmonary disease, congestive heart failure, hypertension, renal failure, antiplatelet drugs, liver diseases. Patients were classified as not frail (score of ≤1) and moderately-severely frail (score ≥2). Kaplan-Meier estimates and multivariable Cox proportional hazard models were used to evaluate the prognostic value adjusted for clinically relevant variables, including age, sex, average length of stay, pre and post-operative KPS, Ki-67, and ASA score.

RESULTS
The duration of follow-up from surgery was 50 months. The median age was 62 years (IQR, 54-71). 283 patients (80.63%) were not frail, and 68 patients (19.37%) were moderately-severely frail. From the overall survival curve, patients' 1-, 2-, and 3-year survival rates were about 51.4%, 19.0%, and 8.2%, respectively. Cox regression analysis revealed a significant association between age (HR, 1.02; 95% confidence interval [CI], 1.01-1.03; p = 0.003) and post KPS (HR, 0.98; 95% CI, 0.97-0.99; p = 0.001) with survival. No association between frailty, survival and length of stay, was found (HR, 1.19; 95% CI, 0.88-1.62; p = 0.26).

CONCLUSION
From preliminary statistical analysis, frailty is not associated with overall survival and length of stay and does not contraindicate neurosurgical treatment. From the statistical analyses we propose to define subgroups of patients who experienced complications related to surgery, characteristics of tumor (site, volume, extent of resection), or for cofactors related to hospitalization. We can improve “fragile” patient’s planning in pre-operative management and post-operative care protocols and determine «long-term consequences» of surgery. Updating this data could define a more effective clinical practice. Finally, we will be able to develop a novel frailty score capable of predicting mortality and severe morbidity outcomes after neurosurgical treatment.