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Yamada K, Yoshii T, Toba M, Egawa S, Morishita S, Matsukura Y, Hirai T, Kudo A, Fushimi K. Trends in the surgical treatment for metastatic spinal tumor in Japanese administrative data between 2012 and 2020. Int J Clin Oncol 2024; 29:911-920. [PMID: 38829471 DOI: 10.1007/s10147-024-02537-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/14/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Both cancer diagnosis/treatment modality and surgical technique for the spine have been developed recently. Nationwide trends in the surgical treatment for metastatic spinal tumors have not been reported in the last decades. This study aimed to examine recent trends in the surgical treatment for spinal metastasis and in-hospital patient outcomes using nationwide administrative hospital discharge data. METHODS The Diagnosis Procedure Combination database from 2012 to 2020 was used to extract data from patients who underwent surgical procedures for spinal metastasis with the number of non-metastatic spinal surgery at the institutions that have performed metastatic spine surgeries at least one case in the same year. Trends in the surgical treatment for spinal metastasis, patients' demographics, and in-hospital mortality/outcomes were investigated. RESULTS This study analyzed 10,321 eligible patients with spinal metastasis. The surgical treatment for spinal metastasis increased 1.68 times from 2012 to 2020, especially in fusion surgery, whereas the proportion of metastatic spinal surgery retained with a slight increase in the 2%s. Distributions of the primary site did not change, whereas age was getting older. In-hospital mortality and length of stay decreased over time (9.9-6.8%, p < 0.001; 37-30 days, p < 0.001). Postoperative complication and unfavorable ambulatory retained stable and slightly decreased, respectively. CONCLUSION During the last decade, surgical treatment for spinal metastasis, especially fusion surgery, has increased in Japan. In-hospital mortality and length of stay decreased. Recent advances in cancer treatment and surgical techniques might influence this trend.
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Affiliation(s)
- Kentaro Yamada
- Department of Orthopaedics and Trauma Research, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedics, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | - Mikayo Toba
- Department of Quality Management Center, Tokyo Medical and Dental Univ Hospital, Tokyo, Japan
| | - Satoru Egawa
- Department of Orthopaedics, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Shingo Morishita
- Department of Orthopaedics, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Yu Matsukura
- Department of Orthopaedics, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Takashi Hirai
- Department of Orthopaedics, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Atsushi Kudo
- Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics Section, Tokyo Medical and Dental University, Tokyo, Japan
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Landriel F, White K, Guiroy A, Silva Á, Carazzo C, Simões C, Giraldo G, Cabrera JP, Molina M, Valacco M, Astur N, Teixeira W, Hem S. Navigating the Indeterminate Zone: Surgeons' Decision-Making Factors in Treating Vertebral Metastases with Spinal Instability Scores of 7-12. World Neurosurg 2024; 185:e1338-e1347. [PMID: 38521221 DOI: 10.1016/j.wneu.2024.03.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 03/16/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND The Spinal Instability Neoplastic Score (SINS) classification system is a validated and the most widely accepted instrument for defining instability in vertebral metastasis (VM), in which lesions scoring between 7 and 12 are defined as indeterminate and the treatment is controversial. This study aimed to determine which variables more frequently are considered by spine surgeons for choosing between the conservative and the surgical treatment of VMs among patients with an indeterminate SINS. METHODS A single-round online survey was conducted with 10 spine surgeons with expertise in the management of VMs from our AO Spine Region. In this survey, each surgeon independently reviewed demographic and cancer-related variables of 36 real-life cases of patients with vertebral metastases scored between 7 and 12 in the SINS. Bivariate and multivariate analyses were performed to identify significant SINS and non-SINS variables influencing the decision-making on surgical treatment. RESULTS The most commonly variables considered important were the SINS element "mechanical pain", rated important for 44.4% of the cases, "lesion type" for 36.1%, and "degree of vertebral collapse" and the non-SINS factor "tumor histology" rated for 13.9% of cases. By far the factor most commonly rated unimportant was "posterior element compromise" (in 72.2% of cases). CONCLUSIONS Surgeons relied on mechanical pain and type of metastatic lesion for treatment choices. Vertebral collapse, spinal malalignment, and mobility were less influential. Spinal mobility was a predictor of surgical versus non-surgical treatment. The only variables not identified either by surgeons themselves or as a predictor of surgery selection was the presence/degree of posterolateral/posterior element involvement.
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Affiliation(s)
- Federico Landriel
- Neurosurgical Department, Spine Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Kevin White
- ScienceRight Research Consulting, Ontario, Canada
| | | | - Álvaro Silva
- Orthopedics Department, Clínica Alemana - Universidad del Desarrollo, Santiago, Chile
| | - Charles Carazzo
- Department of Neurosurgery, Hospital São Vicente de Paula/Universidade de Passo Fundo, Passo Fundo, Brazil
| | - Christiano Simões
- Department of Orthopedic, Hospital Felício Rocho, Belo Horizonte, Brazil
| | - Gustavo Giraldo
- Department of Neurosurgery, Hospital Pablo Tobón Uribe, Clínica Las Américas, Medellín, Colombia
| | - Juan Pablo Cabrera
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, Concepción, Chile
| | - Marcelo Molina
- Orthopedics Department, Spine Unit, Clínica Alemana, Universidad Finis Terrae, Santiago, Chile
| | - Marcelo Valacco
- Orthopedics Department, Spine Unit, Hospital Churruca, Buenos Aires, Argentina
| | - Nelson Astur
- Orthopedics Department, Spine Unit, Hospital Israelita Albert Einstein, Sao Paulo, Sao Paulo, Brazil
| | - William Teixeira
- Department of Orthopedic, Spine Unit, DWO Médicos Associados, São Paulo, Brazil
| | - Santiago Hem
- Neurosurgical Department, Spine Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Kumar N, Hui SJ, Lee R, Athia S, Rothenfluh DA, Tan JH. Implant and construct decision-making in metastatic spine tumour surgery: a review of current concepts with a decision-making algorithm. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1899-1910. [PMID: 38289374 DOI: 10.1007/s00586-023-07987-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 08/15/2023] [Accepted: 10/02/2023] [Indexed: 06/18/2024]
Abstract
STUDY DESIGN Narrative Review. OBJECTIVE Metastatic spine tumour surgery (MSTS) is an important treatment modality of metastatic spinal disease (MSD). Increase in MSTS has been due to improvements in our oncological treatment, as patients have increased longevity and even those with poorer comorbidities are now being considered for surgery. However, there is currently no guideline on how MSTS surgeons should select the appropriate levels to instrument, and which type of implants should be utilised. METHODS The current literature on MSTS was reviewed to study implant and construct decision making factors, with a view to write this narrative review. All studies that were related to instrumentation in MSTS were included. RESULTS A total of 58 studies were included in this review. We discuss novel decision-making models that should be taken into account when planning for surgery in patients undergoing MSTS. These factors include the quality of bone for instrumentation, the extent of the construct required for MSTS patients, the use of cement augmentation and the choice of implant. Various studies have advocated for the use of these modalities and demonstrated better outcomes in MSTS patients when used appropriately. CONCLUSION We have established a new instrumentation algorithm that should be taken into consideration for patients undergoing MSTS. It serves as an important guide for surgeons treating MSTS, with the continuous evolvement of our treatment capacity in MSD. LEVEL OF EVIDENCE IV
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Affiliation(s)
- Naresh Kumar
- Department of Orthopaedic Surgery, University Spine Centre, National University Health System, Level 11, 1E Lower Kent Ridge Road, Singapore, 119228, Singapore.
| | - Si Jian Hui
- Department of Orthopaedic Surgery, University Spine Centre, National University Health System, Level 11, 1E Lower Kent Ridge Road, Singapore, 119228, Singapore
| | - Renick Lee
- Department of Orthopaedic Surgery, University Spine Centre, National University Health System, Level 11, 1E Lower Kent Ridge Road, Singapore, 119228, Singapore
| | - Sahil Athia
- Department of Orthopaedic Surgery, University Spine Centre, National University Health System, Level 11, 1E Lower Kent Ridge Road, Singapore, 119228, Singapore
| | - Dominique A Rothenfluh
- Centre for Spinal Surgery, CHUV University Hospital Lausanne, Rue du Bugnon 46, 1005, Lausanne, Switzerland
| | - Jiong Hao Tan
- Department of Orthopaedic Surgery, University Spine Centre, National University Health System, Level 11, 1E Lower Kent Ridge Road, Singapore, 119228, Singapore
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Mizuta K, Oshiro H, Katsuki R, Tsuha Y, Aoki Y, Tome Y, Nishida K. Denosumab administration for bone metastases from solid tumors: a retrospective cross-sectional study. BMC Cancer 2023; 23:999. [PMID: 37853409 PMCID: PMC10585877 DOI: 10.1186/s12885-023-11495-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/09/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Little is known on how denosumab reduces skeletal-related events (SREs) by bone metastases from solid tumors. We sought to evaluate the effect of denosumab administration in patients with bone metastases from solid tumors. METHODS Data of patients treated with denosumab were collected from electronic medical charts (n = 496). Eligible participants in this study were adult patients (age ≥ 18 years) with metastatic bone lesions from solid tumors treated with denosumab. SREs, surgical interventions, the spinal instability neoplastic score (SINS) for spinal region, and Mirels' score for the appendicular region were evaluated. To assess whether denosumab could prevent SREs and associated surgery, the SINS and Mirels' score were compared between patients with and without SREs. RESULTS A total of 247 patients (median age, 65.5 years old; median follow-up period, 13 months) treated with denosumab for metastatic bone lesions from solid tumors were enrolled in this study. SREs occurred in 19 patients (7.7%). SREs occurred in 2 patients (0.8%) who took denosumab administration before SREs. Surgical interventions were undertaken in 14 patients (5.7%) (spinal and intradural lesions in five patients and appendicular lesions in nine patients). The mean SINS of patients without SREs compared to those with SREs were 7.5 points and 10.2 points, respectively. The mean Mirels' scores of non-SREs patients and those with SREs were 8.07 points and 10.7 points, respectively. Patients with SREs had significantly higher Mirels' score than non-SREs patients (p < 0.01). Patients with SREs had higher SINS than non-SREs patients (p = 0.09). CONCLUSIONS SREs occurred in patients with higher SINS or Mirels' scores. Two patients suffered from SREs though they took denosumab administration before SREs. Appropriate management of denosumab for patients with bone metastasis is significant. Surgical interventions may be needed for patients who with higher SINS or Mirel's scores.
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Affiliation(s)
- Kohei Mizuta
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Okinawa, Japan
| | - Hiromichi Oshiro
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Okinawa, Japan
| | - Ryo Katsuki
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Okinawa, Japan
| | - Yuichi Tsuha
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Okinawa, Japan
| | - Yusuke Aoki
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Okinawa, Japan
| | - Yasunori Tome
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Okinawa, Japan.
| | - Kotaro Nishida
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Okinawa, Japan
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Knöll P, Lenschow M, Lenz M, Neuschmelting V, von Spreckelsen N, Telentschak S, Olbrück S, Weber M, Rosenbrock J, Eysel P, Walter SG. Local Recurrence and Development of Spinal Cord Syndrome during Follow-Up after Surgical Treatment of Metastatic Spine Disease. Cancers (Basel) 2023; 15:4749. [PMID: 37835444 PMCID: PMC10571549 DOI: 10.3390/cancers15194749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/19/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Surgical decompression (SD), with or without posterior stabilization followed by radiotherapy, is an established treatment for patients with metastatic spinal disease with epidural spinal cord compression (ESCC). This study aims to identify risk factors for occurrence of neurological compromise resulting from local recurrence. METHODS All patients who received surgical treatment for metastatic spinal disease at our center between 2011 and 2022 were included in this study. Cases were evaluated for tumor entity, surgical technique for decompression (decompression, hemilaminectomy, laminectomy, corpectomy) neurological deficits, grade of ESCC, time interval to radiotherapy, and perioperative complications. RESULTS A total of 747 patients were included in the final analysis, with a follow-up of 296.8 days (95% CI (263.5, 330.1)). During the follow-up period, 7.5% of the patients developed spinal cord/cauda syndrome (SCS). Multivariate analysis revealed prolonged time (>35 d) to radiation therapy as a solitary risk factor (p < 0.001) for occurrence of SCS during follow-up. CONCLUSION Surgical treatment of spinal metastatic disease improves patients' quality of life and Frankel grade, but radiation therapy needs to be scheduled within a time frame of a few weeks in order to reduce the risk of tumor-induced neurological compromise.
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Affiliation(s)
- Peter Knöll
- Department of Orthopedics, Trauma Surgery and Plastic Surgery, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; (P.K.)
| | - Moritz Lenschow
- Department of General Neurosurgery, Center for Neurosurgery, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; (M.L.); (V.N.); (N.v.S.); (S.T.)
| | - Maximilian Lenz
- Department of Orthopedics, Trauma Surgery and Plastic Surgery, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; (P.K.)
| | - Volker Neuschmelting
- Department of General Neurosurgery, Center for Neurosurgery, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; (M.L.); (V.N.); (N.v.S.); (S.T.)
| | - Niklas von Spreckelsen
- Department of General Neurosurgery, Center for Neurosurgery, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; (M.L.); (V.N.); (N.v.S.); (S.T.)
| | - Sergej Telentschak
- Department of General Neurosurgery, Center for Neurosurgery, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; (M.L.); (V.N.); (N.v.S.); (S.T.)
| | - Sebastian Olbrück
- Department of Orthopedics, Trauma Surgery and Plastic Surgery, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; (P.K.)
- Faculty of Medicine, University of Cologne, 50937 Cologne, Germany
| | - Maximilian Weber
- Department of Orthopedics, Trauma Surgery and Plastic Surgery, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; (P.K.)
| | - Johannes Rosenbrock
- Department of Radiation Oncology, CyberKnife and Radiation Therapy, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany;
| | - Peer Eysel
- Department of Orthopedics, Trauma Surgery and Plastic Surgery, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; (P.K.)
| | - Sebastian G. Walter
- Department of Orthopedics, Trauma Surgery and Plastic Surgery, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; (P.K.)
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von Spreckelsen N, Ossmann J, Lenz M, Nadjiri L, Lenschow M, Telentschak S, Meyer J, Keßling J, Knöll P, Eysel P, Goldbrunner R, Perrech M, Scheyerer M, Celik E, Zarghooni K, Neuschmelting V. Role of Decompressive Surgery in Neurologically Intact Patients with Low to Intermediate Intraspinal Metastatic Tumor Burden. Cancers (Basel) 2023; 15:cancers15020385. [PMID: 36672334 PMCID: PMC9857075 DOI: 10.3390/cancers15020385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Surgical decompression (SD) followed by radiotherapy (RT) is superior to RT alone in patients with metastatic spinal disease with epidural spinal cord compression (ESCC) and neurological deficit. For patients without neurological deficit and low- to intermediate-grade intraspinal tumor burden, data on whether SD is beneficial are scarce. This study aims to investigate the neurological outcome of patients without neurological deficit, with a low- to intermediate-ESCC, who were treated with or without SD. METHODS This single-center, multidepartment retrospective analysis includes patients treated for spinal epidural metastases from 2011 to 2021. Neurological status was assessed by Frankel grade, and intraspinal tumor burden was categorized according to the ESCC scale. Spinal instrumentation surgery was only considered as SD if targeted decompression was performed. RESULTS ESCC scale was determined in 519 patients. Of these, 190 (36.6%) presented with no neurological deficit and a low- to intermediate-grade ESCC (1b, 1c, or 2). Of these, 147 (77.4% were treated with decompression and 43 (22.65%) without. At last follow-up, there was no difference in neurological outcome between the two groups. CONCLUSIONS Indication for decompressive surgery in neurologically intact patients with low-grade ESCC needs to be set cautiously. So far, it is unclear which patients benefit from additional decompressive surgery, warranting further prospective, randomized trials for this significant cohort of patients.
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Affiliation(s)
- Niklas von Spreckelsen
- Department of General Neurosurgery, Center for Neurosurgery, Cologne University Hospital, Faculty of Medicine and University Hospital, University of Cologne, 50937 Cologne, Germany
- Correspondence: (N.v.S.); (V.N.)
| | - Julian Ossmann
- Department of General Neurosurgery, Center for Neurosurgery, Cologne University Hospital, Faculty of Medicine and University Hospital, University of Cologne, 50937 Cologne, Germany
| | - Maximilian Lenz
- Department of Orthopedics and Trauma Surgery, University of Cologne, 50937 Cologne, Germany
| | - Lukas Nadjiri
- Department of Radiooncology and Cyberknife Center, University of Cologne, 50937 Cologne, Germany
| | - Moritz Lenschow
- Department of General Neurosurgery, Center for Neurosurgery, Cologne University Hospital, Faculty of Medicine and University Hospital, University of Cologne, 50937 Cologne, Germany
| | - Sergej Telentschak
- Department of General Neurosurgery, Center for Neurosurgery, Cologne University Hospital, Faculty of Medicine and University Hospital, University of Cologne, 50937 Cologne, Germany
| | - Johanna Meyer
- Department of Orthopedics and Trauma Surgery, University of Cologne, 50937 Cologne, Germany
| | - Julia Keßling
- Department of Orthopedics and Trauma Surgery, University of Cologne, 50937 Cologne, Germany
| | - Peter Knöll
- Department of Orthopedics and Trauma Surgery, University of Cologne, 50937 Cologne, Germany
| | - Peer Eysel
- Department of Orthopedics and Trauma Surgery, University of Cologne, 50937 Cologne, Germany
| | - Roland Goldbrunner
- Department of General Neurosurgery, Center for Neurosurgery, Cologne University Hospital, Faculty of Medicine and University Hospital, University of Cologne, 50937 Cologne, Germany
| | - Moritz Perrech
- Department of General Neurosurgery, Center for Neurosurgery, Cologne University Hospital, Faculty of Medicine and University Hospital, University of Cologne, 50937 Cologne, Germany
| | - Max Scheyerer
- Department of Orthopedics and Trauma Surgery, University of Cologne, 50937 Cologne, Germany
| | - Eren Celik
- Department of Radiooncology and Cyberknife Center, University of Cologne, 50937 Cologne, Germany
| | - Kourosh Zarghooni
- Department of Orthopedics and Trauma Surgery, University of Cologne, 50937 Cologne, Germany
| | - Volker Neuschmelting
- Department of General Neurosurgery, Center for Neurosurgery, Cologne University Hospital, Faculty of Medicine and University Hospital, University of Cologne, 50937 Cologne, Germany
- Correspondence: (N.v.S.); (V.N.)
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Nakajima H, Watanabe S, Honjoh K, Izubuchi Y, Watanabe Y, Tanaka T, Matsumine A. Prognosis after Palliative Surgery for Patients with Spinal Metastasis: Comparison of Predicted and Actual Survival. Cancers (Basel) 2022; 14:cancers14163868. [PMID: 36010862 PMCID: PMC9405944 DOI: 10.3390/cancers14163868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/28/2022] [Accepted: 08/08/2022] [Indexed: 11/18/2022] Open
Abstract
Simple Summary Increased options for cancer treatment have made the prediction of prognosis an important factor in therapeutic decision making. The aim of this study was to assess the clinical significance of prognosis–scoring systems and to identify predictors for 6–month mortality after palliative surgery. The median actual survival period was longer than the predicted life expectancy based on the revised Tokuhashi score and new Katagiri score. However, 21.3% of patients died of cancers within 6 months after palliative surgery. A statistical analysis showed that a higher CRP/albumin ratio (odds ratio: 0.39; cut–off 0.409) and absence of postoperative adjuvant therapy (odds ratio: 7.15) were independent risk factors for poor survival. Our findings suggest the need for careful consideration to determine if palliative surgery is the best option for a patient with these negative prognostic factors, regardless of life expectancy predicted based on a prognosis score. Abstract Prediction of prognosis is a key factor in therapeutic decision making due to recent the development of therapeutic options for spinal metastases. The aim of the study was to examine predictive scoring systems and identify prognostic factors for 6–month mortality after palliative surgery. The participants were 75 patients with spinal metastases who underwent palliative surgery and had a minimum follow–up period of 1 year. Associations of actual survival with categories based on the revised Tokuhashi score and new Katagiri score were evaluated. Univariate and multivariate analyses were performed to identify prognostic factors for 6–month mortality after palliative surgery. The median actual survival period was longer than those predicted using the scoring systems. However, 21.3% of patients died of cancers within 6 months after surgery. A higher CRP/albumin ratio (odds ratio: 0.39; cut–off 0.409) and absence of postoperative adjuvant therapy (odds ratio: 7.15) were independent risk factors for 6–month mortality. There was no association of mortality with primary site, severity of sarcopenia, or other biomarkers. These results suggest that careful consideration is needed to determine whether palliative surgery is the best option for patients with a high preoperative CRP/albumin ratio and/or absence of postoperative adjuvant therapy, regardless of predictions made from scoring systems.
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