Rapid improvements in pain and quality of life are sustained after surgery for spinal metastases in a large prospective cohort

Choi, David; Fox, Zoë; Albert, Todd J.; Arts, Mark P.; Balabaud, L.; Bünger, Cody; Buchowski, Jacob M.; Coppes, Maarten H.; Depreitere, Bart; Fehlings, Michael G.; Harrop, James S.; Kawahara, Norio; Martin-Benlloch, Juan Anthonio; Massicotte, Eric M.; Mazel, Christian; Öner, F. Cumhur; Peul, Wilco C.; Quraishi, Nasir A.; Tokuhashi, Yasuaki; Tomita, Katsuro; Verlaan, Jorrit Jan; Wang, Miao; Wang, Michael; Crockard, H. A.

doi:10.3109/02688697.2015.1133802

Cited by 60 publications

(49 citation statements)

References 30 publications

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“…4,5,20,27,42 Surgical decision-making for this population can be challenging. While surgery can improve overall survival and neurological outcome, and provide pain control, these procedures delay cancer treatments (chemotherapy and radiation) and are resource intensive.…”

Section: Discussionmentioning

confidence: 99%

Application of morphometric analysis to patients with lung cancer metastasis to the spine: a clinical study

Zakaria¹,

Basheer²,

Boyce-Fappiano

et al. 2016

FOC

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OBJECTIVE Predicting the survival rate for patients with cancer is currently performed using the TNM Classification of Malignant Tumors (TNM). Identifying accurate prognostic markers of survival would allow better treatment stratification between more aggressive treatment strategies or palliation. This is especially relevant for patients with spinal metastases, who all have identical TNM staging and whose surgical decision-making is potentially complex. Analytical morphometrics quantifies patient frailty by measuring lean muscle mass and can predict risk for postoperative morbidity after lumbar spine surgery. This study evaluates whether morphometrics can be predictive of survival in patients with spinal metastases. METHODS Utilizing a retrospective registry of patients with spinal metastases who had undergone stereotactic body radiation therapy, the authors identified patients with primary lung cancer. Morphometric measurements were taken of the psoas muscle using CT of the lumbar spine. Additional morphometrics were taken of the L-4 vertebral body. Patients were stratified into tertiles based on psoas muscle area. The primary outcome measure was overall survival, which was measured from the date of the patient's CT scan to date of death. RESULTS A total of 168 patients were identified, with 54% male and 54% having multiple-level metastases. The median survival for all patients was 185.5 days (95% confidence interval [CI] 146–228 days). Survival was not associated with age, sex, or the number of levels of metastasis. Patients in the smallest tertile for the left psoas area had significantly shorter survival compared with a combination of the other two tertiles: 139 days versus 222 days, respectively, hazard ratio (HR) 1.47, 95% CI 1.06–2.04, p = 0.007. Total psoas tertiles were not predictive of mortality, but patients whose total psoas size was below the median size had significantly shorter survival compared with those greater than the median size: 146 days versus 253.5 days, respectively, HR 1.43, 95% CI 1.05–1.94, p = 0.025. To try to differentiate small body habitus from frailty, the ratio of psoas muscle area to vertebral body area was calculated. Total psoas size became predictive of mortality when normalized to vertebral body ratio, with patients in the lowest tertile having significantly shorter survival (p = 0.017). Left psoas to vertebral body ratio was also predictive of mortality in patients within the lowest tertile (p = 0.021). Right psoas size was not predictive of mortality in any calculations. CONCLUSIONS In patients with lung cancer metastases to the spine, morphometric analysis of psoas muscle and vertebral body size can be used to identify patients who are at risk for shorter survival. This information should be used to select patients who are appropriate candidates for surgery and for the tailoring of oncological treatment regimens.

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Section: Discussionmentioning

confidence: 99%

Application of morphometric analysis to patients with lung cancer metastasis to the spine: a clinical study

Zakaria¹,

Basheer²,

Boyce-Fappiano

et al. 2016

FOC

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“…This approach could be regarded as too aggressive for palliative surgery, but as the combined results from different centers in the GSTSG study showed, intraoperative complication rates are often surprisingly high for less invasive surgical procedures. 8 This may be due to the poor clinical condition of these patients. Another explanation is that limited debulking may increase the chance for complications.…”

Section: Comparison Of Different Surgical Proceduresmentioning

confidence: 99%

“…However, in our opinion, a pure en bloc procedure (either intra-or extralesional) is not indicated in the surgical treatment of spinal metastases, except in perhaps rare cases of solitary kidney and breast metastases. Furthermore, in this study we did not differentiate between palliative decompression and debulking (Grade 1 vs Grade 2 in the GSTSG study 8 ) because there were only 4 cases in which a laminectomy without stabilization was performed for metastases in the posterior elements. In all other cases, the decompression was combined with a posterior stabilization procedure.…”

Section: Comparison Of Different Surgical Proceduresmentioning

confidence: 99%

Quality of life after different surgical procedures for the treatment of spinal metastases: results of a single-center prospective case series

Ruiter

Nogarede

Wolfs

et al. 2017

FOC

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OBJECTIVE The performance of surgery for spinal metastases is rapidly increasing. Different surgical procedures, ranging from stabilization alone to stabilization combined with corpectomy, are thereby performed for various indications. Little is known about the impact of these different procedures on patient quality of life (QOL), but this factor is crucial when discussing the various therapeutic options with patients and their families. Thus, the authors of this study investigated the effect of various surgical procedures for spinal metastases on patient QOL. METHODS The authors prospectively followed a cohort of 113 patients with spinal metastases who were referred to their clinic for surgical evaluation between July 2012 and July 2014. Quality of life was assessed using the EQ-5D at intake and at 3, 6, 9, and 12 months after treatment. RESULTS Nineteen patients were treated conservatively, 41 underwent decompressive surgery with or without stabilization, 47 underwent a piecemeal corpectomy procedure with stabilization and expandable cage reconstruction, and 6 had a stabilization procedure without decompression. Among all surgical patients, the mean EQ-5D score was significantly increased from 0.44 pretreatment to 0.59 at 3 months after treatment (p < 0.001). Mean EQ-5D scores at 1 year after surgery further increased to 0.84 following decompression with stabilization, 0.74 after corpectomy with stabilization, and 0.94 after stabilization without decompression. Frankel scores also improved after surgery. There were no significant differences in improvements in EQ-5D scores and Frankel grades among the different surgical procedures. In addition, mortality and complication rates were similar. CONCLUSIONS Quality of life can improve significantly after various extensive and less extensive surgical procedures in patients with spinal metastases. The relatively invasive corpectomy procedure, as compared with alternative less invasive techniques, does not negatively affect outcome.

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“…[49444851] A randomized control trial of patients with metastatic spinal cancer with epidural compression showed that the surgical treatment is superior to radiotherapy alone;[38] the efficacy of surgery has been confirmed independently in the myeloma literature. [2132053] Spinal metastasis scoring systems have been developed[17304950] due to an increasing focus on the outcomes after metastatic surgery,[67243141] however, they have consistently underestimated overall survival (OS) in patients with MM. [1333453] Consequently, surgical decision making for this population is challenging.…”

Section: Introductionmentioning

confidence: 99%

Morphometrics predicts overall survival in patients with multiple myeloma spine metastasis: A retrospective cohort study

Zakaria¹,

Elibe²,

Macki³

et al. 2018

Surg Neurol Int

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Background:Treatment strategies for spinal metastases for myeloma range from conservative measures (radiation and chemotherapy) to invasive (surgical). Identifying better predictors of overall survival (OS) would help in surgical decision making. Analytic morphometrics has been shown to predict survival in oncologic patients, and our study evaluates whether morphometrics is predictive of survival in patients with multiple myeloma (MM) spinal metastases.Methods:For this observational retrospective cohort study, we identified 46 patients with MM spinal metastases who had undergone stereotactic body radiation therapy. OS was the primary outcome measure. Morphometric analysis of the psoas muscle was performed using computed tomography scans of the lumbar spine.Results:OS was statistically correlated with age (P = 0.025), tumor burden (P = 0.023), and number of levels radiated (P = 0.029), but not with gender. Patients in the lowest tertile of average psoas size had significantly shorter survival compared to the highest tertile, hazard ratio (HZ) 6.87 (95% CI = 1.65–28.5, P = 0.008). When calculating the psoas size to vertebral body ratio and correlating this measure to OS, the lowest tertile again had significantly shorter OS compared to the highest tertile, HZ 6.87 (95% CI = 1.57–29.89, P = 0.010); the middle tertile also showed significantly shorter OS compared to the highest tertile, HZ 5.07 (95% CI = 1.34–19.10, P = 0.016). Kaplan–Meier survival curves were used to visually illustrate the differences in survival between different tertiles (Log-rank test P = 0.006).Conclusions:Morphometric analysis successfully predicts long-term survival in patients with MM. More research is needed to validate these results and to see if these methodologies can be applied to other cancer histologies.

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Rapid improvements in pain and quality of life are sustained after surgery for spinal metastases in a large prospective cohort

Cited by 60 publications

References 30 publications

Application of morphometric analysis to patients with lung cancer metastasis to the spine: a clinical study

Application of morphometric analysis to patients with lung cancer metastasis to the spine: a clinical study

Quality of life after different surgical procedures for the treatment of spinal metastases: results of a single-center prospective case series

Morphometrics predicts overall survival in patients with multiple myeloma spine metastasis: A retrospective cohort study

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