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Prost S, Bouthors C, Fuentes S, Charles YP, Court C, Mazel C, Blondel B, Bonnevialle P, Sailhan F. Influence of preoperative biological parameters on postoperative complications and survival in spinal bone metastasis. A multicenter prospective study. Orthop Traumatol Surg Res 2020; 106:1033-1038. [PMID: 32753354 DOI: 10.1016/j.otsr.2019.11.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/01/2019] [Accepted: 11/28/2019] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Onset of spinal bone metastasis is a turning point in the progression of tumoral disease; although incidence is increasing, management is not standardized. Various prognostic scores are available, but advances in medical and surgical treatment have made them less well adapted, and sometimes discordant for a given patient. It would therefore be useful to develop new prognostic instruments. The aim of the present study was to identify biologic risk factors for onset of postoperative complications and death following spinal bone metastasis surgery. MATERIAL AND METHODS A prospective multicenter study included all patients operated on for spinal bone metastasis between November 2015 and May 2017. The main epidemiologic data and biologic data (CRP, albuminemia, calcemia) were collected preoperatively. Surgical strategy, death and/or postoperative complications were collected prospectively. RESULTS Five of the initial 264 patients died during the immediate postoperative course, and 107 within 6 months. At 1 year, 57 patients remained alive. Twenty-six (10%) were lost to follow-up. Preoperative albuminemia<35g/L (29% of patients), calcemia>2.6 nmol/L (8%) and CRP>10mg/L (47.5%) were associated with significantly elevated mortality. Only CRP elevation correlated with postoperative complications rate. CONCLUSION The study confirmed the prognostic value of 3 biologic parameters (CRP level, albuminemia, calcemia) for survival after spinal bone metastasis surgery. A hybrid score taking account of not only clinical but also biologic parameters should be developed to improve estimation of survival.
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Affiliation(s)
- Solène Prost
- CNRS, ISM, unité de chirurgie Rachidienne, Aix-Marseille Université, CHU Timone, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Charlie Bouthors
- Service de chirurgie orthopédique, CHU de Le Kremlin-Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Stéphane Fuentes
- CNRS, ISM, unité de chirurgie Rachidienne, Aix-Marseille Université, CHU Timone, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Yann-Philippe Charles
- Service de chirurgie du rachis, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
| | - Charles Court
- Service de chirurgie orthopédique, CHU de Le Kremlin-Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Christian Mazel
- Institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - Benjamin Blondel
- CNRS, ISM, unité de chirurgie Rachidienne, Aix-Marseille Université, CHU Timone, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France.
| | - Paul Bonnevialle
- Département universitaire d'orthopédie traumatologie, hôpital P.P. Riquet, place Baylac, 31052 Toulouse cedex, France
| | - Frédéric Sailhan
- Université Paris 5, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Clinique Arago, groupe Almaviva Santé, Paris, France
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- SOFCOT, 56, rue Boissonade, 75014 Paris, France
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