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Impact of frailty on survival glioblastoma, IDH-wildtype patients

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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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Data availability

Anonymized data not provided in the article may be shared at the reasonable request of any qualified investigator for purposes of replicating procedures and results.

Abbreviations

5-mFI:

5-item frailty index

CI:

Confidence Interval

IDH:

Isocitrate Dehydrogenase

KPS:

Karnofsky Performance Status

ROTG-RPA:

Therapy Oncology Group - Recursive Partitioning Analysis

uHR:

Unadjusted Hazard Ratio

aHR:

Adjusted Hazard Ratio

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Acknowledgements

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Service de Neurochirurgie H?pital, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, 1, rue Cabanis, Paris, F-75014, France

    Benoît Hudelist, Angela Elia, Alexandre Roux, Luca Paun, Xavier Schumacher, Meissa Hamza, Marco Demasi, Alessandro Moiraghi, Edouard Dezamis, Marc Zanello & Johan Pallud

  2. Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, IMA-Brain, Paris, F-75014, France

    Benoît Hudelist, Angela Elia, Alexandre Roux, Luca Paun, Xavier Schumacher, Meissa Hamza, Marco Demasi, Alessandro Moiraghi, Joseph Benzakoun, Catherine Oppenheim, Marc Zanello & Johan Pallud

  3. Service de Neuropathologie, GHU Paris Psychiatrie et Neurosciences, Site Sainte Anne, Paris, F-75014, France

    Fabrice Chrétien

  4. Service de Neuroradiologie, GHU Paris Psychiatrie et Neurosciences, Site Sainte Anne, Paris, F-75014, France

    Joseph Benzakoun & Catherine Oppenheim

Authors
  1. Benoît Hudelist
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  2. Angela Elia
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Contributions

Experimental design: Benoît HUDELIST, Angela ELIA, Johan PALLUD; Data collection: Benoît HUDELIST, Angela ELIA, Alexandre ROUX, Alessandro MOIRAGHI, Fabrice CHRETIEN, Joseph BENZAKOUN, Catherine OPPENHEIM, Edouard DEZAMIS, Johan PALLUD; Data analysis/interpretation: Benoît HUDELIST, Angela ELIA, Johan PALLUD.Manuscript writing: Benoît HUDELIST, Angela ELIA; Revision and final approval of the manuscript: Benoît HUDELIST, Angela ELIA, Alexandre ROUX, Luca PAUN, Xavier SCHUMACHER, Meissa HAMZA, Marco DEMASI, Alessandro MOIRAGHI, Edouard DEZAMIS, Fabrice CHRETIEN, Joseph BENZAKOUN, Catherine OPPENHEIM, Marc ZANELLO, Johan PALLUD.

Corresponding author

Correspondence to Johan Pallud.

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All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Hudelist, B., Elia, A., Roux, A. et al. Impact of frailty on survival glioblastoma, IDH-wildtype patients. J Neurooncol (2024). https://doi.org/10.1007/s11060-024-04699-y

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