Trent Kite, Teigan Dwyer, Charlotte Drury-Gworek, Tyson Barrett, John Herbst, Rachel Ombres, Leah Herbst, Stephen Karlovits, Rodney E Wegner, Matthew J Shepard
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引用次数: 0
Abstract
Background: The 5-factor modified frailty index (mFI-5) has been increasingly studied in the context of patients with central nervous system tumors. Previously, studies have demonstrated an inverse relationship between increasing mFI-5 scores and overall/progression-free survival in patients with brain metastases (BMs) undergoing stereotactic radiosurgery (SRS).
Methods: A single payer insurance database was queried for patients undergoing SRS for BMs. Patients were stratified based on mFI-5 scores as follows: pre-frail (0-1), frail (2), and severely frail (≥ 3). Survival trends and healthcare utilization rates following treatment were analyzed across each frailty group.
Results: A total of 9927 patients were retrospectively analyzed. Overall survival (OS) was significantly decreased in the frail and severely frail groups compared to pre-frail patients (frail: HR: 1.55, 95% CI: 1.33-1.80, P < .0001) and (severely frail: HR: 2.12, 95% CI: 1.84-2.44, P < .0001). Increased healthcare utilization was observed after SRS in frail and severely frail patients (frail: 90-day RR 1.07, 180-day RR 1.08. and 1-year RR 1.10, P < .0001; severely frail: 90-day RR 1.16, 180-day RR 1.18, 1-year RR 1.21, P < .0001). In patients with established palliative care involvement at the time of SRS, healthcare utilization rates were decreased in the frail and severely frail groups.
Conclusion: Increasing frailty scores portended reduced OS with increased overall healthcare utilization rates. The introduction of palliative care prior to SRS decreased healthcare utilization rates across frailty cohorts.
背景：5因子修正衰弱指数（mFI-5）在中枢神经系统肿瘤患者中的研究越来越多。先前的研究表明，在接受立体定向放射手术（SRS）的脑转移（BMs）患者中，mFI-5评分的增加与总体/无进展生存之间存在反比关系。方法：对脑转移患者进行SRS的单一付款人保险数据库进行查询。根据mFI-5评分对患者进行分层：前期虚弱（0-1）、虚弱(2)和严重虚弱（≥3）。分析每个虚弱组治疗后的生存趋势和医疗保健利用率。结果：共对9927例患者进行回顾性分析。与体弱前患者相比，体弱组和严重体弱组的总生存期（OS）显著降低（体弱：HR: 1.55, 95% CI: 1.33-1.80, P P P P P P）。结论：体弱评分的增加预示着总体医疗利用率的提高会降低OS。在SRS之前引入姑息治疗降低了弱势群体的医疗利用率。
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