How the elderly fare after brain tumor surgery compared to younger patients within a 30-day follow-up: A National surgical Quality Improvement Program analysis of 30,183 cases

Epidemiology of cancer in older adults: a systematic review of age-related differences in solid malignancies treatment

PURPOSE OF REVIEW

We examined the latest epidemiological research on age-related differences in cancer treatment and selected outcomes, among patients with cancer aged 60 and above in comparison to younger patients.

RECENT FINDINGS

Colorectal, pancreatic and lung cancers were studied most often. Most studies were conducted in Europe or the United States of America (USA) within single centers. For unselected patients, older patients receive less treatment, and their survival, regardless of the metric used (cancer-specific survival or overall survival), was poorer than that of middle-aged patients. Age-related differences in treatment and outcomes were more pronounced in patients aged over 80 years. However, among patients selected for treatment, complications, adverse events rates and survival probabilities were comparable between older and younger patients. Treatment differences, especially the omission of therapy, were often smaller for good prognosis cancer types. The likelihood of receiving treatment decreased as age increases, regardless of the cancer types, treatment, countries and setting. More research on treatment in older patients with cancer, especially the frailest and the oldest, is urgently needed as there is still a lack of data to tailor treatment.

Clinicopathological significance of concurrent ErbB receptor expression in human meningioma

In general, human meningiomas grow slowly and have a favourable prognosis; however, some are prone to recur despite their benign histology. Therefore, knowledge of their tumour biology is essential to determine objective biomarkers that can identify cases with an increased risk for recurrence and to generate effective treatment options. Thus, studies on the epidermal growth factor receptor (EGFR) family, comprising ErbB1/EGFR, ErbB2/HER2, ErbB3/HER3 and ErbB4/HER4, are important. We have recently published papers on the expression of each of these receptor proteins in human meningiomas. The present study aimed to assess the clinicopathological significance of their concurrent expression. A total of 185 grade 1 and 2 meningiomas with robust clinical data underwent immunohistochemical analyses with antibodies against the aforementioned receptors. All meningiomas exhibited upregulation of these receptor proteins relative to normal meninges. In addition, the expression of phosphorylated/activated ErbB1/EGFR1 and phosphorylated/activated ErbB2/HER2 was significantly associated with histological malignancy grade and prognosis, respectively. The concurrent upregulation of ErbB receptors in human meningioma supports their fundamental role in the tumourigenesis of these tumours, and they could thus be exploited in diagnostics, prognosis, and ultimately, in targeted clinical interventions.

Intracranial intraoperative radiotherapy (IORT): evaluation of electrocorticography and peri-operative seizure risk

BACKGROUND

Intra-operative radiotherapy (IORT) for brain metastases (BMs) and primary brain tumors has emerged as an adjuvant radiation modality that allows for consolidation of care into a single anesthetic episode with surgical resection. Yet, there is a paucity of data regarding the impact that IORT may have on peri-operative and long-term seizure risk.

METHODS

A retrospective analysis of patients receiving IORT during tumor resection was performed via registry including data regarding peri-operative anti-seizure medications and anesthetic agents. Intra-operative neuromonitoring was performed using electrocorticography (ECoG) captured before-, during-, and after-IORT then analyzed for evidence of seizure or significant baseline changes. Kaplan-Meir estimations were used for overall survival analysis relative to documented clinical seizure incidence post-IORT.

RESULTS

Of the 24 consecutive patients treated with IORT during tumor resection included, 18 (75%) patients were diagnosed with BMs while 6 (25%) had newly-diagnosed glioblastoma. Mean and median survival times were 487 and 372 days, respectively. Clinical seizures occurred in 3 patients post-IORT, 2 BMs patients within 9 months and 1 glioblastoma patient at 14 months. IORT time represented 9.5% of anesthetic time. ECoG recordings were available for 5 patients (4 BMs; 1 glioblastoma), with mean recording durations of 13% of the total anesthetic time and no evidence of high-frequency oscillations or seizure activity.

CONCLUSIONS

IORT is an option for delivery of definitive radiation in surgically resected brain tumors without increasing the peri-operative or long-term risk of seizure. ECoG data during the delivery of radiation fail to demonstrate any electrophysiological changes in response to ionizing radiation.

Preoperative Laboratory Values Are Predictive of Adverse Postoperative Outcomes in Patients Older Than 65 Years Undergoing Brain Tumor Resection: A National Surgical Quality Improvement Program Study

OBJECTIVE

In this study, we used a large national database to assess the effect of preoperative laboratory value (PLV) derangements on postoperative outcomes in patients older than 65 years undergoing brain tumor resection.

METHODS

Data was collected for patients >65 years old undergoing brain tumor resection from 2015 to 2019 (N = 10,525). Univariate and multivariate analysis were performed for 11 PLVs and 6 postoperative outcomes.

RESULTS

Hypernatremia (odds ratio [OR], 4.707; 95% confidence interval [CI], 1.695-13.071; P < 0.01) and increased creatinine level (OR, 2.556; 95% CI, 1.291-5.060; P < 0.01) were the most significant predictors of 30-day mortality. The most significant predictor of Clavien-Dindo grade IV complications was increased creatinine level (OR, 1.667; 95% CI, 1.064-2.613; P < 0.05), whereas, significant predictors of major complications were hypoalbuminemia (OR, 1.426; 95% CI, 1.132-1.796; P < 0.05) and leukocytosis (OR, 1.347; 95% CI, 1.075-1.688; P < 0.05). Predictors of readmission were anemia (OR, 1.326; 95% CI, 1.047-1.680; P < 0.05) and thrombocytopenia (OR, 1.387; 95% CI, 1.037-1.856; P < 0.05), whereas, hypoalbuminemia (OR, 1.787; 95% CI, 1.280-2.495; P < 0.001) was predictive of reoperation. Increased partial thromboplastin time and hypoalbuminemia were predictors of extended length of stay (OR, 2.283, 95% CI, 1.360-3.834, P < 0.01 and OR, 1.553, 95% CI, 1.553-1.966, P < 0.001, respectively). Hypernatremia (OR, 2.115; 95% CI, 1.181-3.788; P < 0.05) and hypoalbuminemia (OR, 1.472; 95% CI, 1.239-1.748; P < 0.001) were the most significant predictors of NHD. Seven of 11 PLVs were associated with adverse postoperative outcomes.

CONCLUSIONS

PLV derangements were significantly associated with adverse postoperative outcomes in patients older than 65 years undergoing brain tumor resection. The most significant predictors of adverse postoperative outcomes were hypoalbuminemia and leukocytosis.

Outcomes After Supratentorial Craniotomy for Primary Malignant Brain Tumor Resection in Adult Patients: A National Surgical Quality Improvement Program Analysis

BACKGROUND

The rate of complications remains significant after craniotomy for supratentorial primary malignant brain tumors despite recent advances.

OBJECTIVE

The goal of this study is to characterize factors associated with these complications.

METHODS

Data were extracted from the National Surgical Quality Improvement Program database from 2016 to 2019. Patients who underwent a craniotomy for resection of supratentorial primary malignant brain tumors were included. Covariates included demographics/comorbidities, preoperative laboratory values, American Society of Anesthesiologists (ASA) classification, operative time, and postoperative complications. Multivariable logistic regression with backward and forward selection was used to evaluate independent predictors of death, prolonged hospitalization, postoperative stroke with neurologic deficit (CVA), and unplanned readmission. Predictive fit of the model was evaluated using the area under the receiver operating curve (AUC).

RESULTS

Of 8965 included cases, the 30-day postoperative risks were 1.9% for CVA, 10.1% for unplanned readmission, 1.2% for prolonged hospitalization, and 2.4% for death. Age, ASA category, disseminated cancer, preoperative functional dependence, and postoperative respiratory complications were predictors of 30-day mortality (AUC, 0.83; P < 0.001). CVA was best predicted by increased operation time (P < 0.001), age, ASA category, and recent weight loss (AUC, 0.63; P = 0.009). Prolonged hospitalization was predicted by nonelective surgery status, time from admission to surgery, reintubation, and postoperative sepsis (AUC, 0.78; P < 0.001). Unplanned readmission was predicted by chronic steroid use, postoperative thrombotic complications after surgery, organ/space surgical site infection, deep vein thrombosis, postoperative systemic sepsis, and septic shock (AUC, 0.68; P < 0.001).

CONCLUSIONS

Our study identifies predictors of major 30-day complications after craniotomy for this subset of patients with brain tumor.

Quality of Life after Surgical Treatment of Brain Tumors

Quality of life is one of the parameters that characterize the success of brain tumor treatments, along with overall survival and a disease-free life. Thus, the main aim of this research was to evaluate the quality of life after the surgical treatment of brain tumors. The research material included 236 patients who were to undergo surgery for brain tumors. The participants completed the quality of life questionnaires EORTC QLQ-C30 (version 3.0) and EORTC QLQ-BN20 on the day of admission to the department, on the fifth day after the removal of the brain tumor, and thirty days after the surgical procedure. Descriptive statistics, Student's t-test, the Kruskal-Wallis test, the Shapiro-Wolf test, ANOVA, and Fisher's least significant difference post hoc test were performed. The mean score of the questionnaire before the surgical procedure amounted to 0.706, 5 days after surgery it amounted to 0.614, and 30 days after surgery to 0.707. The greatest reduction in the quality of life immediately after the procedure was observed in patients with low-grade glial tumors (WHO I, II) and extracerebral tumors (meningiomas and neuromas). Thirty days after surgery, an improvement in the quality of life was observed in all included groups. The greatest improvement was recorded in the group of patients operated on for meningioma and neuroblastoma, and the lowest in patients treated for metastatic tumors. Contemporary surgical procedures used in neurosurgery reduce the quality of life in patients with brain tumors only in the early postoperative period. Histopathological diagnoses of these tumors impact the quality of life of patients.

Frailty Status Is a More Robust Predictor Than Age of Spinal Tumor Surgery Outcomes: A NSQIP Analysis of 4,662 Patients

Objective

The present study aimed to evaluate the effect of baseline frailty status (as measured by modified frailty index-5 [mFI-5]) versus age on postoperative outcomes of patients undergoing surgery for spinal tumors using data from a large national registry.

Methods

The National Surgical Quality Improvement Program database was used to collect spinal tumor resection patients’ data from 2015 to 2019 (n = 4,662). Univariate and multivariate analyses for age and mFI-5 were performed for the following outcomes: 30-day mortality, major complications, unplanned reoperation, unplanned readmission, hospital length of stay (LOS), and discharge to a nonhome destination. Receiver operating characteristic (ROC) curve analysis was used to evaluate the discriminative performance of age versus mFI-5.

Results

Both univariate and multivariate analyses demonstrated that mFI-5 was a more robust predictor of worse postoperative outcomes as compared to age. Furthermore, based on categorical analysis of frailty tiers, increasing frailty was significantly associated with increased risk of adverse outcomes. ‘Severely frail’ patients were found to have the highest risk, with odds ratio 16.4 (95% confidence interval [CI],11.21–35.44) for 30-day mortality, 3.02 (95% CI, 1.97–4.56) for major complications, and 2.94 (95% CI, 2.32–4.21) for LOS. In ROC curve analysis, mFI-5 score (area under the curve [AUC] = 0.743) achieved superior discrimination compared to age (AUC = 0.594) for mortality.

Conclusion

Increasing frailty, as measured by mFI-5, is a more robust predictor as compared to age, for poor postoperative outcomes in spinal tumor surgery patients. The mFI-5 may be clinically used for preoperative risk stratification of spinal tumor patients.