The Clinical Frailty Scale as useful tool in patients with brain metastases

Abstract

Purpose The Clinical Frailty Scale (CFS) evaluates patients’ level of frailty on a scale from 1 to 9 and is commonly used in geriatric medicine, intensive care and orthopedics. The aim of our study was to reveal whether the CFS allows a reliable prediction of overall survival (OS) in patients after surgical treatment of brain metastases (BM) compared to the Karnofsky Performance Score (KPS). Methods Patients operated for BM were included. CFS and KPS were retrospectively assessed pre- and postoperatively and at follow-up 3–6 months after resection. Results 205 patients with a follow-up of 22.8 months (95% CI 18.4–27.1) were evaluated. CFS showed a median of 3 (“managing well”; IqR 2–4) at all 3 assessment-points. Median KPS was 80 preoperatively (IqR 80–90) and 90 postoperatively (IqR 80–100) as well as at follow-up after 3–6 months. CFS correlated with KPS both preoperatively (r = − 0.92; p < 0.001), postoperatively (r = − 0.85; p < 0.001) and at follow-up (r = − 0.93; p < 0.001). The CFS predicted the expected reduction of OS more reliably than the KPS at all 3 assessments. A one-point increase (worsening) of the preoperative CFS translated into a 30% additional hazard to decease (HR 1.30, 95% CI 1.15–1.46; p < 0.001). A one-point increase in postoperative and at follow-up CFS represents a 39% (HR 1.39, 95% CI 1.25–1.54; p < 0.001) and of 42% risk (HR 1.42, 95% CI 1.27–1.59; p < 0.001). Conclusion The CFS is a feasible, simple and reliable scoring system in patients undergoing resection of brain metastasis. The CFS 3–6 months after surgery specifies the expected OS more accurately than the KPS.

Prognostic assessment in patients operated for brain metastasis from systemic tumors

“…[5][6][7] Several models for prognostic assessment have been developed and continuously improved in the last 25 years, 19 however, only few recent investigations specifically focus on the subgroup of operated patients. [25][26][27][28] Lacking sufficient data, development of standardized criteria for prognostic assessment in these patients remains challenging. According to current guidelines, 9 the detection of single or symptomatic BM are indications for surgical resection, in particular if rapid relief from symptoms from increased intracranial pressure can be provided.…”

“… 5 , 6 , 7 Several models for prognostic assessment have been developed and continuously improved in the last 25 years, 19 however, only few recent investigations specifically focus on the subgroup of operated patients. 25 , 26 , 27 , 28 Lacking sufficient data, development of standardized criteria for prognostic assessment in these patients remains challenging.…”

Special populations in metastatic renal cell carcinoma

“…None of the examined first-line clinical trials enrolled patients with a KPS less than 70 or an ECOG Performance Status of greater than 1, which corresponds to any patient who requires occasional assistance (KPS 60) or any patient capable of self-care but unable to carry on work activities (ECOG 2) [46,47]. That being said, there have been several publications questioning the reliability of these simplified scoring systems for accurately determining frailty in various patient populations [48,49].…”

Temporal muscle thickness has no prognostic relevance in patients with high-grade glioma compared to functional scales

“…In comparison to KPS, it allows one to assess patients independently including a variety of patient’s restrictions regarding physical and mental health. CFS showed superior prediction of OS in patients with high-grade glioma and brain metastases in relation to KPS ( 1 , 2 ).…”

“…Frailty is a relevant prognostic factor in patients with high-grade glioma and brain metastases, resulting in significant worsening of functionality and shorter overall survival (OS) in frail patients ( 1 , 2 ). These patients can be identified using a variety of scoring systems.…”