Clinical Frailty Is an Important Predictor of Functional Outcome following Surgical Resection in Patients with High-Grade Meningiomas

Introduction: High-grade meningiomas (WHO grades II and III), represent approximately 20% of all meningiomas but are characterized by markedly increased recurrence and aggression. As meningioma incidence increases progressively with age, the impact of patient frailty on postoperative quality of life becomes an increasingly relevant question. While several scales for quantifying frailty exist, they are inconsistently utilized and have not been studied in relation to postoperative outcomes in a large patient cohort of high-grade meningiomas. This study presents a thorough evaluation of the impact of preoperative frailty on postsurgical quality of life in patients with high-grade meningiomas in the largest such cohort of its kind to date.

Methods: A retrospective review was performed to identify all patients who underwent surgical resection for WHO grade II and III meningiomas at our institution between 1995 and 2019. Extensive data on patient demographics, frailty measures, surgical parameters, and quality of life were collected. In particular, frailty measures include Clinical Frailty Index (CFI), Charlson’s comorbidity index (CCI), and age. Postoperative Karnofsky’s performance scores (KPS) at the 3-month and 12-month follow-up appointments were utilized as a proxy for quality of life after surgical resection. Patients with inadequate documentation were excluded from the study. Multivariate analysis was performed to determine the best-fit model for postoperative KPS scores based on a variety of patient and tumor-specific variables. The model that yielded the lowest Akaike’s information criteria (AIC) was selected as the final model.

Results: A total of 253 patients were included in the final analysis. A total of141 patients (55.7%) were female, and 112 patients (44.3%) were male. The mean CFI and CCI were 3.68 ± 1.21 and 4.52 ± 1.98, respectively. Tumor location was as follows: skull base—75 (29.6%); convexity—63 (24.9%); parasagittal/falcine—92 (36.4%); and other—23 (9.1%). On multivariate analysis, three independent factors were significantly associated with lower KPS scores both the 3-month and 12-month postoperative time points: (1) black race (3 months: p = 0.0012, 12 months: p < 0.001), (2) CFI (3 months: p = 0.045, 12 months: p = 0.039), and (3) laterality of tumor location (3 months: p = 0.047, 12 months: p = 0.014). Two factors associated with higher postoperative KPS scores were higher values of preoperative KPS (3 months: p < 0.001, 12 months: p = 0.023) and grade III tumor (3 months: p = 0.0022, 12 months: p = 0.0058). CCI was not selected to be in the final model as it did not minimize AIC.

Conclusion: Frailty using CFI and preoperative KPS were significantly correlated with postoperative quality of life following surgical resection in patients with high-grade meningiomas. Patients with lower preoperative CFI tend to have worse postoperative functional outcomes, while patients with higher preoperative KPS scores tend to have significantly higher functional outcomes after surgery. Our results underlie the importance of appropriate patient selection and preoperative optimization to minimize frailty in patients undergoing surgical resection for high-grade meningiomas. Further are needed to evaluate if functional optimization preoperatively in frailer patients may have a positive impact on postoperative quality of life in patients with high-grade meningiomas.

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