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Hudelist B, Elia A, Roux A, Paun L, Schumacher X, Hamza M, Demasi M, Moiraghi A, Dezamis E, Chrétien F, Benzakoun J, Oppenheim C, Zanello M, Pallud J. Impact of frailty on survival glioblastoma, IDH-wildtype patients. J Neurooncol 2024; 169:61-72. [PMID: 38762828 DOI: 10.1007/s11060-024-04699-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 04/26/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE Frailty increases the risk of mortality among patients. We studied the prognostic significance of frailty using the modified 5-item frailty index (5-mFI) in patients harboring a newly diagnosed supratentorial glioblastoma, IDH-wildtype. METHODS We retrospectively reviewed records of patients surgical treated at a single neurosurgical institution at the standard radiochemotherapy era (January 2006 - December 2021). Inclusion criteria were: age ≥ 18, newly diagnosed glioblastoma, IDH-wildtype, supratentorial location, available data to assess the 5-mFI index. RESULTS A total of 694 adult patients were included. The median overall survival was longer in the non-frail subgroup (5-mFI < 2, n = 538 patients; 14.3 months, 95%CI 12.5-16.0) than in the frail subgroup (5-mFI ≥ 2, n = 156 patients; 4.7 months, 95%CI 4.0-6.5 months; p < 0.001). 5-mFI ≥ 2 (adjusted Hazard Ratio (aHR) 1.31; 95%CI 1.07-1.61; p = 0.009) was an independent predictor of a shorter overall survival while age ≤ 60 years (aHR 0.78; 95%CI 0.66-0.93; p = 0.007), KPS score ≥ 70 (aHR 0.71; 95%CI 0.58-0.87; p = 0.001), unilateral location (aHR 0.67; 95%CI 0.52-0.87; p = 0.002), total removal (aHR 0.54; 95%CI 0.44-0.64; p < 0.0001), and standard radiochemotherapy protocol (aHR 0.32; 95%CI 0.26-0.38; p < 0.0001) were independent predictors of a longer overall survival. Frailty remained an independent predictor of overall survival within the subgroup of patients undergoing a first-line oncological treatment after surgery (n = 549) and within the subgroup of patients who benefited from a total removal plus adjuvant standard radiochemotherapy (n = 209). CONCLUSION In newly diagnosed supratentorial glioblastoma, IDH-wildtype patients treated at the standard combined radiochemotherapy era, frailty, defined using a 5-mFI score ≥ 2 was an independent predictor of overall survival.
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Affiliation(s)
- Benoît Hudelist
- Service de Neurochirurgie H?pital, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, 1, rue Cabanis, Paris, F-75014, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, IMA-Brain, Paris, F-75014, France
| | - Angela Elia
- Service de Neurochirurgie H?pital, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, 1, rue Cabanis, Paris, F-75014, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, IMA-Brain, Paris, F-75014, France
| | - Alexandre Roux
- Service de Neurochirurgie H?pital, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, 1, rue Cabanis, Paris, F-75014, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, IMA-Brain, Paris, F-75014, France
| | - Luca Paun
- Service de Neurochirurgie H?pital, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, 1, rue Cabanis, Paris, F-75014, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, IMA-Brain, Paris, F-75014, France
| | - Xavier Schumacher
- Service de Neurochirurgie H?pital, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, 1, rue Cabanis, Paris, F-75014, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, IMA-Brain, Paris, F-75014, France
| | - Meissa Hamza
- Service de Neurochirurgie H?pital, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, 1, rue Cabanis, Paris, F-75014, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, IMA-Brain, Paris, F-75014, France
| | - Marco Demasi
- Service de Neurochirurgie H?pital, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, 1, rue Cabanis, Paris, F-75014, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, IMA-Brain, Paris, F-75014, France
| | - Alessandro Moiraghi
- Service de Neurochirurgie H?pital, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, 1, rue Cabanis, Paris, F-75014, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, IMA-Brain, Paris, F-75014, France
| | - Edouard Dezamis
- Service de Neurochirurgie H?pital, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, 1, rue Cabanis, Paris, F-75014, France
| | - Fabrice Chrétien
- Service de Neuropathologie, GHU Paris Psychiatrie et Neurosciences, Site Sainte Anne, Paris, F-75014, France
| | - Joseph Benzakoun
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, IMA-Brain, Paris, F-75014, France
- Service de Neuroradiologie, GHU Paris Psychiatrie et Neurosciences, Site Sainte Anne, Paris, F-75014, France
| | - Catherine Oppenheim
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, IMA-Brain, Paris, F-75014, France
- Service de Neuroradiologie, GHU Paris Psychiatrie et Neurosciences, Site Sainte Anne, Paris, F-75014, France
| | - Marc Zanello
- Service de Neurochirurgie H?pital, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, 1, rue Cabanis, Paris, F-75014, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, IMA-Brain, Paris, F-75014, France
| | - Johan Pallud
- Service de Neurochirurgie H?pital, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, 1, rue Cabanis, Paris, F-75014, France.
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, IMA-Brain, Paris, F-75014, France.
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Manzetti M, Ruffilli A, Viroli G, Traversari M, Ialuna M, Salamanna F, Neri S, Faldini C. Frailty Influence on Postoperative Surgical Site Infections After Surgery for Degenerative Spine Disease and Adult Spine Deformity. Can a Frailty Index be a Valuable Summary Risk Indicator? A Systematic Review and Metanalysis of the Current Literature. Global Spine J 2024:21925682241235605. [PMID: 38382093 DOI: 10.1177/21925682241235605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
STUDY DESIGN Metanalysis. OBJECTIVE Surgical site infections (SSI) is one of the commonest postoperative adverse events after spine surgery. Frailty has been described as a valuable summary risk indicator for SSI in spine surgery. The aim of this metanalysis is to evaluate the influence of frailty on postoperative SSI in this cohort and provide hints on which index can predict the risk of SSI. METHODS Papers describing the postoperative SSI rate in adult degenerative spine disease or adult spine deformity patients with varying degrees of frailty were included in the analysis. The SSI rate in different grades of frailty was considered for outcome measure. Meta-analysis was performed on studies in whom data regarding patients with different levels of frailty and occurrence of postoperative SSI could be pooled. P < .05 was considered significant. RESULTS 16 studies were included. The frailty prevalence measured using mFI-11 ranged from 3% to 17.9%, these values were inferior to those measured with mFI-5. Significant difference was found between frail and non-frail patients in postoperative SSI rate at metanalysis (z = 5.9547, P < .0001 for mFI-5 and z = 3.8334, P = .0001 for mFI-11). CONCLUSION This is the first meta-analysis to specifically investigate the impact of frailty, on occurrence of SSI. We found a relevant statistical difference between frail and non-frail patients in SSI occurrence rate. This is a relevant finding, as the ageing of population increases alongside with spine surgery procedures, a better understanding of risk factors may advance our ability to treat patients while minimizing the occurrence of SSI.
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Affiliation(s)
- Marco Manzetti
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Biomedical and Neuromotor Science - DIBINEM, University of Bologna, Bologna, Italy
| | - Alberto Ruffilli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Biomedical and Neuromotor Science - DIBINEM, University of Bologna, Bologna, Italy
| | - Giovanni Viroli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Biomedical and Neuromotor Science - DIBINEM, University of Bologna, Bologna, Italy
| | - Matteo Traversari
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Ialuna
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesca Salamanna
- Surgical Science and Technology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Simona Neri
- Medicine and Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Cesare Faldini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Biomedical and Neuromotor Science - DIBINEM, University of Bologna, Bologna, Italy
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