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首页> 外文期刊>Neurosurgical focus >Multivariate risk factor analysis and literature review of postoperative deterioration in Karnofsky Performance Scale score in elderly patients with skull base meningioma
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Multivariate risk factor analysis and literature review of postoperative deterioration in Karnofsky Performance Scale score in elderly patients with skull base meningioma

机译：老年颅底脑膜瘤患者卡诺夫斯基绩效量表评分的多因素危险因素分析及文献复习

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OBJECTIVE Elderly patients are particularly at risk for severe morbidity following surgery. Among the various risk factors, age and skull base location of meningioma are known to be poor prognostic factors in meningioma surgery. The authors conducted this study to analyze significant preoperative risk factors in elderly patients with skull base meningioma. METHODS A total of 265 elderly patients (≥ 65 years old) with meningioma were surgically treated at the authors’ institute and affiliated hospitals between 2000 and 2016, and these cases were reviewed. Among them, 57 patients with skull base meningioma were evaluated. Among the various risk factors, the authors analyzed age, sex, Karnofsky Performance Scale (KPS) score, American Society of Anesthesiologists score, and tumor size, location, and pathology. Body mass index (BMI) and serum albumin were investigated as the frailty factors. The authors also reviewed 11 surgical studies of elderly patients ≥ 60 years old with meningioma. RESULTS The mean age was 72.4 ± 5.7 years, and 42 patients were female (73.6%). The mean size of meningioma was 36.6 ± 14.8 mm at the maximum diameter, and the mean follow-up period was 31.1 ± 31.5 months. (The continuous variables are expressed as the mean ± SD.) Histopathological investigation revealed a higher incidence (71.9%) of WHO Grade I. The rates of deterioration after surgery, at 3 months, and at 1 year were 33.3%, 37.3%, and 39.1%, respectively. Univariate analysis revealed location, preoperative KPS score, BMI level 2, and serum albumin level (p = 0.010, 0.017, 0.0012, and 0.0019, respectively) to be poor prognostic factors. Multivariate analysis revealed that location (p = 0.038) and BMI (p = 0.035) were risk factors for KPS score deterioration immediately after surgery. According to the 11 papers reviewed, the median rate (25th–75th percentile) of skull base–related location was 43.5% (39.6–47.75); for asymptomatic status the mean was 24%; and for mortality at 3 months and 1 year the medians were 6.3% (0.7–7.1) and 8% (4.8–9.4), respectively. CONCLUSION Careful preoperative assessment based on the frailty concept was essential for better outcome in elderly patients with skull base meningioma. The BMI is appropriate as a quantitative factor for measure of frailty, particularly in elderly individuals with skull base meningioma. Further prospective randomized controlled trials are necessary to validate frailty as a preoperative risk factor. Not only patient selection but also surgical timing was an important factor.
机译：目的老年患者在手术后特别有发生严重疾病的风险。在各种危险因素中，脑膜瘤的年龄和颅底位置已知是脑膜瘤手术的不良预后因素。作者进行了这项研究，以分析老年颅底脑膜瘤患者的重要术前危险因素。方法在2000年至2016年期间，在作者所在的研究所和附属医院对265名年龄≥65岁的脑膜瘤老年患者进行了手术治疗，并对这些病例进行了回顾。其中，对57例颅底脑膜瘤患者进行了评估。在各种危险因素中，作者分析了年龄，性别，卡诺夫斯基绩效量表（KPS）评分，美国麻醉医师学会评分以及肿瘤的大小，位置和病理。研究了体重指数（BMI）和血清白蛋白作为脆弱因素。作者还回顾了11例≥60岁脑膜瘤老年患者的手术研究。结果平均年龄为72.4±5.7岁，其中42例为女性（73.6％）。最大直径处的脑膜瘤平均大小为36.6±14.8 mm，平均随访时间为31.1±31.5个月。 （连续变量表示为平均值±SD。）组织病理学调查显示，世卫组织I级患者的发病率更高（71.9％）。术后3个月和1年的恶化率分别为33.3％，37.3％，和39.1％。单因素分析显示位置，术前KPS评分，BMI 2级和血清白蛋白水平（分别为p = 0.010、0.017、0.0012和0.0019）是不良的预后因素。多因素分析显示，手术后即刻位置（p = 0.038）和BMI（p = 0.035）是KPS评分恶化的危险因素。根据所审查的11篇论文，与颅底有关的位置的中位率（第25-75％）为43.5％（39.6-47.75）。无症状状态的平均值为24％;对于3个月和1年的死亡率，中位数分别为6.3％（0.7-7.1）和8％（4.8-9.4）。结论基于脆弱概念的术前仔细评估对于老年颅底脑膜瘤患者取得更好的预后至关重要。 BMI适合作为衡量身体虚弱的定量因素，特别是在患有颅底脑膜瘤的老年人中。需要进一步的前瞻性随机对照试验来验证脆弱作为术前危险因素。不仅患者选择，而且手术时机也是重要因素。

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