Commentary on "Baseline Frailty Measured by the Risk Analysis Index and 30-Day Mortality After Surgery for Spinal Malignancy: Analysis of a Prospective Registry (2011-2020)".
Journal
Neurospine
Series/Report No.
Neurospine
Journal Volume
21
Journal Issue
2
Start Page
414-415
ISSN
2586-6583
Date Issued
2024-06
Author(s)
DOI
10.14245/ns.2448560.280
Abstract
In the past decades, thanks to medical advances, the survival of cancer patients has improved, and the incidence of the spine metastasis has also increased.Numerus studies have focused on predicting the survival of spine metastasis patients, leading to the development of several prediction systems such as Tomita score, revised Tokuhashi score, modified Bauer score, New England Spine Metastasis Scores, SORG nomogram etc. 1 While surgery for spine metastasis primarily aims for the mechanical stabilization and neurological restoration, the patient's postoperative survival is a crucial factor that should be considered preoperatively.In addition to survival, frailty has garnered increasing interests. 2Frailty is a recognized geriatric syndrome that predicts poor outcomes and is characterized by and age-related and precipitous decline in function.It also indicates a reduced ability to recover from physiological stresses.For instance, in a surgical cohort of spine metastasis from non-small cell lung cancer, aggressive surgery showed longer overall survival and progression-free survival to ambulatory patients compared to palliation surgery, but it also demonstrated higher mortality rates at the 30 and 90 days. 3Assessing frailty is therefore critical in the decisionmaking process for surgery. 4The Modified Frailty Index (mFI), a cumulative and weighted deficit model developed by Rockwood et al., 5 is considered an appropriate risk stratification tool in spine surgery. 4However, in the context of the spine metastasis surgery, the mFI does not account for the impact of systemic treatment-chemotherapy, disease burden, and performance status-ECOG, which are important factors in determined how well a patient can tolerate the surgery. 2 Nutritional status is also related to survival and complications following spine metastasis surgery. 6Besides survival prediction and frailty evaluation, nutrition plays an important role in the postoperative course and should be considered in treatment plan, though it is not a part of 5-factor mFI (mFI-5) or 11-factor mFI evaluations.Consequently, new tools are being developed.The Metastatic Spinal Tumor Frailty Index, which includes nine independent variables such as malnutrition and surgical invasiveness, 7 has been frequently studied but lack predictive validity.The Hospital Frailty Risk Score has shown positive predic-Neurospine
SDGs
Publisher
Korean Spinal Neurosurgery Society
Type
other