A systematic review on frailty indices utilized in oncologic surgery and radiotherapy for metastatic spine disease: A critical appraisal of components and performance

IF 3.2 Q3 Medicine

North American Spine Society Journal Pub Date : 2025-12-01 Epub Date: 2025-09-12 DOI:10.1016/j.xnsj.2025.100794

Ali Haider Bangash MBBS , Rose Fluss MD , Sertac Kirnaz MD , Jason D. Nosrati MD , Byung-Han Rhieu MD , Justin Tang MD, MS , Madhur K. Garg MBA, MD , Saikiran G. Murthy DO , Yaroslav Gelfand MD , Reza Yassari MD , Rafael De la Garza Ramos MD

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引用次数: 0

Abstract

Background

Frailty assessment is becoming increasingly important for risk stratification in metastatic spine disease (MSD) management. However, the optimal frailty assessment tool for this population remains undefined. The aim of this systematic review was to critically evaluate frailty indices utilized in surgical and radiotherapeutic management of MSD by appraising their components and predictive performance.

Methods

We systematically searched PubMed, Cochrane, and Epistemonikos from inception until November 13, 2024 for studies exploring frailty indices in MSD management. Methodological quality assessment was undertaken using the Methodological index for nonrandomized studies (MINORS) and Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tools. We evaluated indices for comprehensiveness by assessing if they included measures across 8 dimensions (comorbidity burden, mobility, cognition, mood, social vulnerability, nutrition, energy, and function). We also assessed their predictive utility for mortality and complications.

Results

Out of a total of 42 studies, 15 studies reporting on 61,663 patients (Mean age: 63 years; 44% female) met the inclusion criteria. All studies were of moderate quality based on MINORS analysis. Six frailty indices were identified, with all including comorbidities while none incorporating energy measures. The Hospital Frailty Risk Score was the most comprehensive (75% of frailty spectrum). Predictive performance varied considerably across studies, with inconsistent associations with complications and mortality after both: surgical and radiotherapeutic interventions.

Conclusions

Contemporary frailty indices showed substantial heterogeneity in both composition and predictive performance for MSD outcomes. The inconsistent performance and incomplete capture of frailty dimensions underscored the need for developing a novel frailty index that incorporates oncologic factors and balances comprehensive evaluation with clinical feasibility to help guide treatment decisions between surgery and radiotherapy for patients with MSD.

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对转移性脊柱疾病的肿瘤手术和放疗中使用的脆弱指数的系统回顾：对成分和性能的关键评估

背景：虚弱评估在转移性脊柱疾病（MSD）管理的风险分层中变得越来越重要。然而，这一人群的最佳脆弱性评估工具仍未确定。本系统综述的目的是通过评估其组成部分和预测性能，批判性地评估MSD手术和放疗管理中使用的脆弱指标。方法系统检索PubMed、Cochrane和Epistemonikos自成立之日起至2024年11月13日，检索MSD管理中脆弱指标的相关研究。采用非随机研究方法学指数（minor）和诊断准确性研究质量评估-2 （QUADAS-2）工具进行方法学质量评估。我们通过评估是否包括8个维度（共病负担、流动性、认知、情绪、社会脆弱性、营养、能量和功能）的措施来评估指标的全面性。我们还评估了它们对死亡率和并发症的预测效用。结果在42项研究中，有15项研究报告了61,663例患者（平均年龄：63岁，女性44%），符合纳入标准。根据minor分析，所有研究均为中等质量。确定了六个虚弱指数，所有指数都包括合并症，但没有一个纳入能量测量。医院虚弱风险评分是最全面的（虚弱谱的75%）。不同研究的预测表现差异很大，与手术和放疗干预后的并发症和死亡率的关联不一致。结论当代衰弱指数在MSD结果的组成和预测性能上都存在很大的异质性。不一致的表现和虚弱维度的不完整捕获强调了开发一种新的虚弱指数的必要性，该指数包含肿瘤因素，并平衡综合评估与临床可行性，以帮助指导MSD患者在手术和放疗之间的治疗决策。

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