Journal of Neuro-Oncology最新文献

{"title":"A feasibility trial of delayed resection for brain metastases following pre-operative stereotactic radiosurgery.","authors":"Christina Schröder, Neda Haghighi, Claire Phillips, Cristian Udovicich, Michelle P Li, Katharine Drummond, James Dimou, Andrew S Davidson, Joseph Sia","doi":"10.1007/s11060-025-05081-2","DOIUrl":"https://doi.org/10.1007/s11060-025-05081-2","url":null,"abstract":"<p><strong>Purpose: </strong>Pre-operative stereotactic radiosurgery (SRS) for brain metastases (BrM), an emerging alternative to post-operative SRS, is typically performed 1-2 days before resection. However, a longer period of the irradiated tumour in situ may confer anti-tumour immunological benefits. We conducted the first clinical trial to evaluate the feasibility of planned delayed resection after pre-operative SRS.</p><p><strong>Methods: </strong>In this single-arm trial, patients with suspected BrM suitable for pre-operative SRS and surgery were eligible. The primary endpoint was feasibility of resection 7-21 days after SRS, with a pre-defined feasibility threshold of 66% receiving this. Secondary endpoints included 6-month adverse events (AE) and local control (LC) rates. Tumour volume change was assessed from SRS- and neurosurgery-planning MRI's.</p><p><strong>Result: </strong>78 patients were screened and the target accrual of 15 patients was met. Common reasons for pre-operative SRS ineligibility were lack of existing cancer diagnosis (44%) and tumour size/peri-tumoural oedema (18%). Two patients declined resection after SRS. The median SRS-to-surgery interval was 8 days (range 0-15). Nine tumours in 8 patients (56%) received delayed resection. Reasons for earlier resection were predominantly non-medical. There were no Grade > 2 AE. The 6-month BrM LC was 100%. At a median follow-up of 13.8 months, the only BrM local failure after SRS and resection occurred with a 0-day SRS-to-surgery interval. No histopathological diagnosis issues were encountered with delayed resection. An increased SRS-to-surgery interval correlated with greater tumour shrinkage.</p><p><strong>Conclusions: </strong>The pre-defined feasibility threshold for delayed resection was not met, but more than half of patients received delayed resection without safety concerns.</p><p><strong>Trial registration number: </strong>ACTRN12622001372774 (Registered 26/10/2022).</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144150668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survival prediction in glioblastoma: 10-year follow-up from the Dutch Neurosurgery Quality Registry.","authors":"Jeroen T J M van Dijck, Hilko Ardon, Rutger K Balvers, Eelke M Bos, Lisette Bosscher, H Bart Brouwers, Vincent K Y Ho, Koos Hovinga, Lesley Kwee, Mark Ter Laan, Rob J A Nabuurs, Pierre A J T Robe, Sarita van Geest, Olivier van der Veer, Niels Verburg, Michiel Wagemakers, Philip C de Witt Hamer, Mar Rodriguez Girondo, Rishi D S Nandoe Tewarie","doi":"10.1007/s11060-025-05080-3","DOIUrl":"https://doi.org/10.1007/s11060-025-05080-3","url":null,"abstract":"<p><strong>Purpose: </strong>Glioblastoma is the most common and treatment-resistant primary malignant brain tumor, with high morbidity and mortality despite standard treatment protocols. This study aims to evaluate survival and prognostic factors, and introduce two pragmatic prognostic models to inform individualized, patient-centered decision-making, using a large Dutch registry.</p><p><strong>Methods: </strong>We analyzed a prospective cohort of 7621 patients (2012-2022) in 12 Dutch centers via the Dutch Quality Registry Neurosurgery. Univariate analysis of prognostic factors, Kaplan-Meier survival curves, and funnel plots comparing center performance (30-day and 2-year mortality) were conducted. Two prognostic models using multivariate Cox regression were developed.</p><p><strong>Results: </strong>Glioblastoma incidence was 3.9/100.000 in The Netherlands. Overall, 30-day mortality was 5.1% and 2-year survival 17.8%. Overall median survival was 10.4 months, with 4.6 months after biopsy and 12.9 months post-resection. Poorer survival correlated with older age, higher ASA classification, lower Karnofsky Performance Status, biopsy over resection (HR 0.49, 95% CI 0.47-0.52), and postoperative complications (HR 1.57 95% CI 1.39-1.79). MGMT promotor methylation (HR 0.58, 95% CI 0.53-0.63) and adjuvant treatment were linked to lower mortality. Treatment variation and outcomes were within expected ranges; surgical volume did not affect survival. The prognostic models had C-indices of 0.704 (6-month) and 0.721 (2-year).</p><p><strong>Conclusion: </strong>Surgical resection and adjuvant therapy improved survival, but prognosis remained poor. Age, premorbid condition, treatment and molecular markers influenced survival. Center variations were within expected range, and higher surgical volume did not improve outcomes. The developed prognostic models could potentially inform clinicians, pending external validation.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive value of early DCE and DSC perfusion MRI parameters for midterm clinical outcomes in lung cancer brain metastases treated with stereotactic radiosurgery.","authors":"Yunus Emre Senturk, Enes Muhammed Canturk, Ahmet Peker, Sabahattin Yüzkan, Yavuz Samancı, Selçuk Peker","doi":"10.1007/s11060-025-05054-5","DOIUrl":"https://doi.org/10.1007/s11060-025-05054-5","url":null,"abstract":"<p><strong>Purpose: </strong>Stereotactic Radiosurgery (SRS) is an effective way of controlling the brain metastasis (BM) of lung carcinoma. This study evaluates the performance of dynamic contrast-enhanced MRI (DCE-MRI) and dynamic susceptibility contrast MRI (DSC-MRI) parameters to distinguish responders from non-responders at midterm follow-up in lung carcinoma BMs.</p><p><strong>Methods: </strong>Twenty-six patients (mean age 62 ± 10 years) with 54 lung carcinoma BMs (NSCLC 67%, SCLC 33%) underwent SRS. The DCE-MRI and DSC-MRI were performed at baseline and repeated 4-8 weeks post-SRS to predict treatment responses at the midterm follow-up (6-12 months). Midterm outcomes were classified according to RANO-BM criteria as responders (complete response, partial response, or stable disease) or non-responders (progressive disease). Receiver operating characteristic (ROC) analyses evaluated the diagnostic accuracy of individual perfusion parameters and their combinations.</p><p><strong>Results: </strong>Forty lesions (74%) were responders, while 14 (26%) were non-responders. Progressive lesions showed a mean volume increase of 5.5-fold, whereas responders demonstrated a 60% mean volume reduction. Responders showed significantly lower absolute post-SRS K-trans (median 0.015 vs. 0.035 min⁻¹; p = 0.005), a higher proportional decrease in K-trans from baseline (- 27% vs. +13%; p = 0.017), and lower post-SRS Ve (p = 0.009) compared to non-responders. Absolute post-SRS K-trans had the highest individual predictive accuracy (AUC = 0.75, accuracy = 78%, sensitivity = 86%, specificity = 55%). Neither the dynamic change nor post-SRS nCBV alone predicted midterm response; however, combining post-SRS nCBV with K-trans slightly improved predictive performance (AUC = 0.76, accuracy = 79%).</p><p><strong>Conclusion: </strong>Early post-SRS absolute K-trans is the best perfusion parameter for predicting midterm response in lung carcinoma BMs. DSC-MRI parameters alone offer limited predictive value.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconsideration of the resection strategy of eloquent brain metastasis in the era of postoperative stereotactic radiotherapy: a comparative analysis with non-eloquent metastasis.","authors":"Levin Häni, Danial Nasiri, Antonia Gächter, Artem Klimov, Mattia Branca, Nicole Söll, Andreas Raabe, Daniel M Aebersold, Evelyn Herrmann, Ekin Ermiş, Sonja Vulcu, Nicolas Bachmann, Philippe Schucht","doi":"10.1007/s11060-025-05075-0","DOIUrl":"https://doi.org/10.1007/s11060-025-05075-0","url":null,"abstract":"<p><strong>Purpose: </strong>To decrease the recurrence rate after complete resection of a brain metastasis, removal of a surgical safety margin is advocated. This is not always feasible when resecting a metastasis in an eloquent location. We aimed to assess the recurrence rate after resection of metastases in an eloquent location followed by postoperative stereotactic radiotherapy to the resection cavity.</p><p><strong>Methods: </strong>We retrospectively included patients with 1-3 brain metastases undergoing gross total resection and postoperative stereotactic radiotherapy between 2010 and 2022. Primary endpoint was local recurrence free survival (LRFS). Secondary endpoints were overall survival and distant brain failure free survival. Patients were grouped according to the location of their metastasis into eloquent and non-eloquent. Eloquent localization was considered a surrogate for resection without a surgical safety margin according to our institutional practice.</p><p><strong>Results: </strong>We included 193 patients with 201 resected metastases. Ninety-five metastases (47.3%) were classified as eloquent and 106 (52.7%) as non-eloquent. Kaplan-Meier analysis showed no difference in LRFS between eloquent and non-eloquent metastases (HR 0.821, 95%-CI 0.447-1.507, p = 0.523). Only increased preoperative tumor volume was associated with worse LRFS (HR 1.015, 95% CI 1.001-1.028, p = 0.033). There was no difference concerning secondary endpoints between eloquent and non-eloquent metastases.</p><p><strong>Conclusion: </strong>Omission of a surgical safety margin in at least a part of the resection cavity due to eloquence of adjacent tissue had no detrimental effect on local control after resection and postoperative stereotactic radiotherapy of a brain metastasis. This could influence the strategy during resection of an eloquent metastasis.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring perspectives on skull base chordoma management: a modified Delphi approach to consensus.","authors":"Saket Myneni, A Karim Ahmed, Foad Kazemi, Anirudh Saraswathula, Nathan T Zwagerman, Shirley Y Su, Garret Choby, Eric W Wang, Jamie J Van Gompel, Kristin J Redmond, Erin L McKean, Carl H Snyderman, Paul A Gardner, Nicholas R Rowan, Debraj Mukherjee","doi":"10.1007/s11060-025-05088-9","DOIUrl":"https://doi.org/10.1007/s11060-025-05088-9","url":null,"abstract":"<p><strong>Objective: </strong>Current treatment for skull base chordomas utilizes both surgical resection and adjuvant radiation, but recent studies have demonstrated evidence that has brought the use of adjuvant radiotherapy into question. Chordomas differ greatly in molecular makeup and proliferation. These factors have led to significant variation in management across providers. We used a modified Delphi approach to work towards consensus on standardized operative definitions and evidence-based management of chordomas.</p><p><strong>Methods: </strong>Our multidisciplinary panel included participants representing the AANS/CNS Tumor Section and North American Skull Base Society (NASBS) with a track record of publishing on chordoma management. Our approach involved a four-step process: one statement-generation round, two voting rounds to establish consensus and refine statements, and a final external validation round by NASBS members. Anonymous voting was completed via Qualtrics surveys.</p><p><strong>Results: </strong>The statement-generation process produced 65 statements. Through the Delphi process, 36 statements reached consensus during the first round and an additional 17 were refined for further consensus in the second round. Moderate (67-80%) or strong (> 80%) consensus was achieved for 43 final statements. Forty-one items were externally validated. There was consensus that an endoscopic endonasal approach should be utilized whenever possible. They defined the tumor characteristics (molecular and cytogenic) to consider before offering adjuvant radiotherapy.</p><p><strong>Conclusions: </strong>This modified Delphi study generated consensus on 41 statements regarding skull base chordoma management. These statements aim to shed light on the consensus among providers regarding the use of surgery, neoadjuvant radiation, adjuvant radiation, adjuvant systemic therapies, and treatment of recurrence for chordoma.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeting COL5A1 enhances anoikis thus attenuating malignancy of glioblastoma via inhibiting the Wnt/β-catenin signaling pathway.","authors":"Mingjing Zhou, Wei Wu, Yichang Wang, Beichen Zhang, Xuyan Zhao, Haoyu Zhou, Yiyang Cao, Pancheng Wu, Maode Wang, Jia Wang","doi":"10.1007/s11060-025-05036-7","DOIUrl":"https://doi.org/10.1007/s11060-025-05036-7","url":null,"abstract":"<p><strong>Purpose: </strong>As one of the most prevalent primary brain tumors, glioblastoma (GBM) is characterized by its severe malignancy and extremely poor prognosis. Recent studies have demonstrated that targeting anoikis and malignancy showed impressed efficiency for treatment in a wide range of solid tumors, however, relevant research on GBM still remains unclarified.</p><p><strong>Methods: </strong>In this study, genes related with malignancy and anoikis of GBM were identified by utilizing the Cancer Genome Atlas (TCGA), the Chinese Glioma Genome Atlas (CGGA) and the Molecular Signatures Database (MSigDB). Subsequently, the role of the key gene was validated via proliferation, invasion and migration experiments both in conditions with and without attachment. Moreover, RNA sequencing analysis was employed to reveal further mechanisms.</p><p><strong>Results: </strong>Here, Type V collagen alpha 1 (COL5A1) was identified as a critical gene associated with anoikis and poor outcomes. Additionally, COL5A1 knockdown induced significant reduction in malignancy of GBM both in vitro and in vivo. Moreover, cell anoikis was remarkable enhanced by reduced expression of COL5A1 after low-attachment cell culture. Mechanically, RNA sequencing analysis revealed that the activity of the Wnt/β-catenin signaling pathway was diminished following COL5A1 knockdown, which indicated that COL5A1 reduced anoikis via regulating Wnt/β-catenin signaling pathway thus promoted malignancies of GBM cells.</p><p><strong>Conclusion: </strong>These findings demonstrated the novel evidence that COL5A1 serves as an essential regulatory factor influencing both anoikis and malignancy of GBM cells by regulating Wnt/β-catenin signaling pathway, indicating that COL5A1 could be a novel prognosis-related biomarker and potential therapeutic target for GBM.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimodal MRI radiomics enhances epilepsy prediction in pediatric low-grade glioma patients.","authors":"Tianyou Tang, Yuxin Wu, Xinyu Dong, Xuan Zhai","doi":"10.1007/s11060-025-05073-2","DOIUrl":"https://doi.org/10.1007/s11060-025-05073-2","url":null,"abstract":"<p><strong>Background: </strong>Determining whether pediatric patients with low-grade gliomas (pLGGs) have tumor-related epilepsy (GAE) is a crucial aspect of preoperative evaluation. Therefore, we aim to propose an innovative, machine learning- and deep learning-based framework for the rapid and non-invasive preoperative assessment of GAE in pediatric patients using magnetic resonance imaging (MRI).</p><p><strong>Methods: </strong>In this study, we propose a novel radiomics-based approach that integrates tumor and peritumoral features extracted from preoperative multiparametric MRI scans to accurately and non-invasively predict the occurrence of tumor-related epilepsy in pediatric patients.</p><p><strong>Results: </strong>Our study developed a multimodal MRI radiomics model to predict epilepsy in pLGGs patients, achieving an AUC of 0.969. The integration of multi-sequence MRI data significantly improved predictive performance, with Stochastic Gradient Descent (SGD) classifier showing robust results (sensitivity: 0.882, specificity: 0.956).</p><p><strong>Conclusion: </strong>Our model can accurately predict whether pLGGs patients have tumor-related epilepsy, which could guide surgical decision-making. Future studies should focus on similarly standardized preoperative evaluations in pediatric epilepsy centers to increase training data and enhance the generalizability of the model.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Glioma-derived SPARCL1 promotes the formation of peritumoral neuron-glioma synapses.","authors":"Yang Li, Yao Wang, Xingyue Han, Jing Xu, Enyu Liu, Jingmin Cheng, Yuan Ma, Tao Yang, Jianping Wu, Haodong Sun, Kexia Fan, Danyi Shen, Jie Li, Xin Chen, Sixun Yu, Haifeng Shu","doi":"10.1007/s11060-025-05069-y","DOIUrl":"https://doi.org/10.1007/s11060-025-05069-y","url":null,"abstract":"","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diffuse hemispheric glioma, H3 G34-mutant: defining the clinical picture through a single institution case series and literature analysis.","authors":"Andrew Williams, Bryan Neth, Mason Webb, Jonathan Schwartz, David Daniels, Samantha Caron, Jian Campian, Joon Uhm, Cristiane Ida, William G Breen, Aditya Raghunathan, Ugur Sener","doi":"10.1007/s11060-025-05028-7","DOIUrl":"https://doi.org/10.1007/s11060-025-05028-7","url":null,"abstract":"<p><strong>Purpose: </strong>Diffuse hemispheric glioma, H3 G34-mutant (DHG, H3 G34) is an uncommon new tumor type defined in the World Health Organization 2021 classification. DHG, H3 G34 primarily affects children and young adults. There is paucity of knowledge regarding its demographic and prognostic factors. We present an institutional case series and a comprehensive literature review to better determine factors contributing to overall survival.</p><p><strong>Methods: </strong>We included an institutional case series (n = 6) and comprehensively reviewed previously published individual cases of DHG, H3 G34 through January 2025. A total of 514 individual cases of DHG, H3 G34 were identified and utilized for analyses (n = 257 with individual level survival data). We performed survival analysis using the Kaplan-Meier method and Cox regression.</p><p><strong>Results: </strong>Median age of the cohort was 16 years (range: 1-66 years). Median OS was 21 months. OS was improved with gross total resection compared to subtotal resection and biopsy only (Log-rank p < 0.001). Patients with primary tumor location in the right hemisphere had longer OS relative to other tumor locations (Log-rank p < 0.001). Patients with H3 p.G35V (G34V) mutations as opposed to p.G35R mutations had shorter OS (Log-rank p = 0.01). There was no difference in survival outcomes by patient age, MGMT promoter methylation status, the presence of TP53/ATRX/PDGFRA mutations or contrast enhancement.</p><p><strong>Conclusions: </strong>We present the largest combined data set of patients with DHG, H3 G34 to date and describe in greater clarity the prognostic factors which impact survival in this disease. Unlike many primary brain tumors including glioblastoma and tumors in adolescents and young adults, survival does not appear to be significantly impacted by age.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing combined effects of risk analysis index-revised (RAI-rev), malnutrition, and anemia on morbidity and mortality after spine surgery for metastatic spinal tumors.","authors":"Aladine A Elsamadicy, Paul Serrato, Shaila D Ghanekar, Ethan D L Brown, Max Ward, Zach Pennington, Daniel Schneider, Sheng-Fu Larry Lo, Daniel M Sciubba","doi":"10.1007/s11060-025-05071-4","DOIUrl":"https://doi.org/10.1007/s11060-025-05071-4","url":null,"abstract":"<p><strong>Purpose: </strong>This study evaluates the combined effects of frailty, anemia, and malnutrition on outcomes in spinal metastases patients.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the 2011-2022 NSQIP database. Adult patients undergoing spinal surgery for spinal metastases were identified using CPT and ICD codes and stratified based on Risk Analysis Index-revised (RAI-rev) frailty status; frail patients were subdivided based on anemia and malnutrition status. Our primary outcomes were extended hospital length of stay (LOS), 30-day adverse events (AEs), non-routine discharge (NRD), and 30-day mortality. For each outcome, we fitted four nested multivariable logistic regression models (RAI-rev + anemia + malnutrition, RAI-rev + anemia, RAI-rev + malnutrition, and RAI-rev alone) and compared the incremental discrimination of each model using receiver operating characteristic (ROC) analysis.</p><p><strong>Results: </strong>1530 patients were stratified accordingly: 355 Frail Alone, 540 Frail + Anemic, 85 Frail + Malnourished, 407 Frail + Anemic + Malnourished, and 143 Not Frail. RAI-rev and malnourishment were risk factors for extended LOS ((RAI-rev: aOR 1.04, 95% CI 1.01-1.08; malnourishment: aOR 1.98, 95% CI 1.44-2.73)) and mortality (RAI-rev: aOR: 1.07, 95% CI 1.03-1.11; malnourishment: aOR: 2.37, 95% CI 1.50-3.75). RAI-rev (aOR 1.02, 95% CI 1.00-1.03) and anemia (aOR 2.06, 95% CI 1.50-2.84) independently predicted AEs and malnourishment predicted NRD (aOR 1.56, 95% CI 1.15-2.13). On ROC analysis, RAI-rev + anemic + malnourished superiorly predicted extended LOS (p = 0.021), AEs (p = 0.035), and mortality (p = 0.023) compared to RAI-rev. RAI-rev + malnourished outperformed RAI-rev in predicting extended LOS (p = 0.035) and mortality (p = 0.020). RAI-rev + anemic outperformed RAI-rev in predicting AEs (p = 0.032).</p><p><strong>Conclusion: </strong>Our study suggests that RAI-rev-defined frailty combined with anemia and malnutrition is a superior predictor of outcomes in spinal metastases patients.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}