Evaluating the Predictive Value of the Modified Frailty Index (mFI-5) on Postoperative Outcomes in Patients with High-Grade Gliomas

Purpose: High-grade gliomas (HGGs) are aggressive brain tumors associated with significant morbidity. This study aims to assess the utility of the 5-factor Modified Frailty Index (mFI-5) in predicting postoperative outcomes and overall survival in patients undergoing surgical resection for HGGs.Methods: We conducted a retrospective analysis of 196 patients treated surgically for GBM at our institution from January 2016 to January 2023. Patients were stratified into three groups based on their preoperative mFI-5 scores: prefrail (< 2), frail (= 2), and severely frail (> 2). Primary outcomes included 30-day, 90-day, and 1-year survival and progression-free survival. Secondary outcomes focused on hospital length of stay (LOS), 30-day readmission rates, and discharge status. Univariate and multivariate analyses evaluated the impact of frailty on these outcomes.Results: Frailty was significantly associated with adverse outcomes. The median progression free survival was 9.2 months in the prefrail, 6.9 months in the frail and 3.5 months in severely frail patients (p = 0.01). Furthermore, the 90-day OS was 89%, 91% and 75% for the prefrail, frail and severely frail group respectively (p = 0.03). However, there was no statistically significant difference in 12-month OS (64%, 70%, 58%; p = 0.72). The median survival for the cohort was 17.9 months in the prefrail, 15.4 months in the frail and 15.3 in the severely frail (p = 0.02). Severely frail patients demonstrated lower rates of symptomatic resolution (66%,53%, 33% respectively; p = 0.005), increased non-home discharge rates (24%, 55.9%, 75%, respectively; P < 0.001), and mRS > 2 upon discharge (5%, 26%, and 66% respectively; P < 0.001).Conclusion: The mFI-5 is a valuable tool for preoperative risk stratification in patients with GBM, predicting short-term survival and postoperative outcomes. Integrating frailty assessments into preoperative evaluations can aid in tailoring surgical and adjuvant therapies, potentially improving patient outcomes and optimizing resource allocation. This study supports the adoption of frailty assessments in neuro-oncological practice to enhance personalized care strategies for patients with HGGs.