Surgical Resection Predicts Overall Survival even in Frail Patients with IDH- wildtype Glioblastomas

Purpose: The aim of this study was to evaluate the role of frailty required in the surgical risk assessment in old patients with IDH-wildtype glioblastoma on surgical outcome, overall survival, and functional dependency. Methods We reviewed records of old and frail patients surgical treated at our institution between January 2018 to May 2021. Inclusion criteria were : 1) neuropathological diagnosis of IDH-wildtype glioblastoma; 2) patient older than 65 years at the time of surgery; 3) available data to assess the frailty index according to the 5-mFI. Results A total of 47 patients were included. The 5-mFI was at 0 in 11 cases (23.4%), at 1 in 30 cases (63.83%), at 2 in 2 cases (4.25%), at 3 in 2 cases (4.25%), at 4 in 2 cases (4.25%). A GTR was performed in 26 patients (55.3%), a STR was performed in 13 patients (27.6%), and a B was performed in 8 patients (17.1%). The rate of 30-day postoperative complications was higher in B and in the 5-mFI = 4 subgroup (p > 0.05). GTR and age ≤ 70 years were independent predictors of a longer overall survival (p < 0.005). Sex, 5-mFI, postoperative complications, and preoperative KPS status did not independently influence overall survival and functional dependency. Conclusion In aged patients with IDH-wildtype glioblastoma, GTR is still an independent predictor of longer survival and good postoperative functional recovery whatever the frailty index. The 5-mFI score does not influence surgery and outcomes. Further confirmatory analyses are required.