Journal article
The 5-factor modified frailty index as a prognostic factor following stereotactic radiosurgery for metastatic disease to the brain from non-small cell lung cancer: A multi-center cohort analysis
Journal of clinical neuroscience, v 132, p110979
01 Feb 2025
PMID: 39673841
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
•The 5-factor modified frailty index (mFI5) is a simple prognostic tool which can predict patient outcomes.•Increased frailty is associated with a decreased Overall Survival (OS)•Age > 65 was associated with decreased OS.•A novel composite scoring system combining age and mFI5 correlates with survival.•Using the mFI5, enhanced patientt selection for radiosurgery in NSCLC brain metastases is possible.
Non-small cell lung cancer (NSCLC) patients often develop brain metastases (BMs), complicating management. We have shown that increasing frailty is associated with decreased overall survival (OS) and central nervous system progression free survival (PFS) for patients undergoing stereotactic radiosurgery (SRS) to BMs. Leveraging the International Radiosurgery Research Foundation, we sought to expand upon these findings, in NSCLC specifically.
Across four institutions, 193 patients with (≥1) NSCLC derived BMs with minimum 3 months of clinical/radiographic follow-up were analyzed. Primary outcomes included OS and PFS. Patients were stratified utilizing the mFI-5 into pre-frail (0–1), frail (2), and severely frail (3 + ).
Increased frailty was associated with diminished OS (frail hazard ratio (HR) = 2.49, 95 % CI [1.61–3.85]; severely frail HR = 2.65, 95 % CI [1.57–4.45]). The 6-month post-SRS survival rate was 86.1 %, 69.5 % and 54.5 % for pre-frail, frail and severely frail patients, respectively (p < 0.001). Frailty was not significantly predictive of time to PFS on multivariate Cox Proportional Hazards analysis although there was a trend towards diminished PFS with increasing frailty (median PFS was 18.4, 8.0, and 7.4 months for pre-frail, frail, and severely frail, respectively (p = 0.11). As age > 65 was also predictive of shorter OS (HR = 1.78, 95 % CI [1.23–2.56]). We generated a novel scoring system incorporating age and frailty status. The median survival of patients that scored 0, 1, 2, and 3 points were 21.1, 18.3, 8.9, and 5.6 months, respectively (p < 0.001). The area under the curve of the validation cohort using a logistic regression model was 0.77.
Our results indicate that the MFI-5 is a promising metric with application at the point of care to provide decision support for patients with NSCLC derived BMs.
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Details
- Title
- The 5-factor modified frailty index as a prognostic factor following stereotactic radiosurgery for metastatic disease to the brain from non-small cell lung cancer: A multi-center cohort analysis
- Creators
- Sujay Rajkumar - Drexel UniversityTrent Kite - Allegheny Health NetworkJay Desai - Drexel UniversityThomas Lucido - Drexel UniversityDavid Mathieu - Université de SherbrookeManjul Tripathi - Post Graduate Institute of Medical Education and ResearchNavneet Singh - Post Graduate Institute of Medical Education and ResearchNarendra Kumar - Post Graduate Institute of Medical Education and ResearchGeorgios Mantziaris - Neurological SurgeryStylianos Pikis - University of VirginiaJason P. Sheehan - Neurological SurgeryRodney E. Wegner - Drexel UniversityMatthew J. Shepard - Drexel University
- Publication Details
- Journal of clinical neuroscience, v 132, p110979
- Publisher
- Elsevier Ltd
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Neurology
- Web of Science ID
- WOS:001389088100001
- Scopus ID
- 2-s2.0-85211621959
- Other Identifier
- 991022155291004721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Clinical Neurology
- Neurosciences