Systemic considerations for the surgical treatment of spinal metastatic disease: a scoping literature review

MacLean, Mark A.; Touchette, Charles J; Georgiopoulos, Miltiadis; Brunette‐Clément, Tristan; Abduljabbar, Fahad H.; Ames, Christopher P.; Bettegowda, Chetan; Charest-Morin, Raphaële; Dea, Nicolas; Fehlings, Michael G.; Gokaslan, Ziya L.; Goodwin, C. Rory; Laufer, Ilya; Netzer, Cordula; Rhines, Laurence D.; Sahgal, Arjun; Shin, John H.; Sciubba, Daniel M.; Stephens, Byron F.; Fourney, Daryl R.; Weber, Michael H.

doi:10.1016/s1470-2045(22)00126-7

Cited by 17 publications

(24 citation statements)

References 74 publications

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“…In cases of spinal metastases with motor paralysis and/or intractable pain, preoperative PS does not necessarily reflect the general condition. Therefore, oncologists and spine surgeons should use decision making frameworks such as NOMS in their decision making [ 11 ]. Nevertheless, in cases of spinal metastases that require urgent palliative surgery without any preoperative detailed pathological diagnosis because of spinal metastasis, the informed consent about the prognosis should be obtained more carefully.…”

Section: Discussionmentioning

confidence: 99%

“…At our hospital, patients with progressive neurological deficits or intractable pain were selected as candidates for palliative surgery if the life expectancy was predicted to be over approximately 6 months by using prognosis–scoring systems, opinions from oncologists, and the neurologic, oncologic, mechanical, and systemic (NMOS) framework [ 11 ]. However, contrary to our preoperative predictions, some patients survived for ≤6 months after palliative surgery.…”

Section: Introductionmentioning

confidence: 99%

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Prognosis after Palliative Surgery for Patients with Spinal Metastasis: Comparison of Predicted and Actual Survival

Nakajima

Watanabe

Honjoh

et al. 2022

Cancers

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prognosis after Palliative Surgery for Patients with Spinal Metastasis: Comparison of Predicted and Actual Survival

Nakajima

Watanabe

Honjoh

et al. 2022

Cancers

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“…The AOSKFT conducted a systematic scoping review of the literature to identify preoperative systemic considerations associated with postoperative clinical outcomes in patients receiving surgery for SMD. 4 Subsequently, the AOSKFT performed a modified Delphi technique where members were surveyed regarding potential surrogate markers of frailty and clinically relevant outcomes in the context of SMD and survey questions were selected. 20 The 33-question survey (Supplementary Material A) was reviewed to reduce redundancy, optimize question clarity, and ensure face and content validity.…”

Section: Survey Development and Testingmentioning

confidence: 99%

“…Despite clear surgical indications for patients with SMD, 22 decision-making remains complicated by numerous preoperative oncological and systemic variables. 4 Tools capturing systemic condition and oncological disease burden have been independently used to estimate survival and guide SMD-related decision-making. 5,[23][24][25] Most of these tools are outdated, suffer from poor accuracy, and lack systemic variables known to influence clinical outcomes in this patient population.…”

Section: Decision-making In Smd: a Persistent Challengementioning

confidence: 99%

“…Prognostication of SMD-related surgical outcomes remains complicated by the need to consider numerous preoperative systemic variables known to influence postoperative outcomes, including demographics, medical comorbidities, biochemical abnormalities, poor ambulation, reduced performance status, and systemic disease burden. 4 An improved ability to assess patients' systemic condition and estimate physical reserve may potentially aid risk stratification, facilitate targeted optimization or reversal of dynamic health conditions, and ease the decision-making process.…”

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confidence: 99%

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Perception of frailty in spinal metastatic disease: international survey of the AO Spine community

MacLean

Georgiopoulos

Charest-Morin

et al. 2023

Journal of Neurosurgery: Spine

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OBJECTIVE Frailty has not been clearly defined in the context of spinal metastatic disease (SMD). Given this, the objective of this study was to better understand how members of the international AO Spine community conceptualize, define, and assess frailty in SMD. METHODS The AO Spine Knowledge Forum Tumor conducted an international cross-sectional survey of the AO Spine community. The survey was developed using a modified Delphi technique and was designed to capture preoperative surrogate markers of frailty and relevant postoperative clinical outcomes in the context of SMD. Responses were ranked using weighted averages. Consensus was defined as ≥ 70% agreement among respondents. RESULTS Results were analyzed for 359 respondents, with an 87% completion rate. Study participants represented 71 countries. In the clinical setting, most respondents informally assess frailty and cognition in patients with SMD by forming a general perception based on clinical condition and patient history. Consensus was attained among respondents regarding the association between 14 preoperative clinical variables and frailty. Severe comorbidities, extensive systemic disease burden, and poor performance status were most associated with frailty. Severe comorbidities associated with frailty included high-risk cardiopulmonary disease, renal failure, liver failure, and malnutrition. The most clinically relevant outcomes were major complications, neurological recovery, and change in performance status. CONCLUSIONS The respondents recognized that frailty is important, but they most commonly evaluate it based on general clinical impressions rather than using existing frailty tools. The authors identified numerous preoperative surrogate markers of frailty and postoperative clinical outcomes that spine surgeons perceived as most relevant in this population.

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Determining patients with spinal metastases suitable for surgical intervention: A cost‐effective analysis

Hsieh,

Yen,

Tseng

et al. 2023

Cancer Medicine

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BackgroundBoth nonoperative and operative treatments for spinal metastasis are expensive interventions. Patients' expected 3‐month survival is believed to be a key factor to determine the most suitable treatment. However, to the best of our knowledge, no previous study lends support to the hypothesis. We sought to determine the cost‐effectiveness of operative and nonoperative interventions, stratified by patients' predicted probability of 3‐month survival.MethodsA Markov model with four defined health states was used to estimate the quality‐adjusted life years (QALYs) and costs for operative intervention with postoperative radiotherapy and radiotherapy alone (palliative low‐dose external beam radiotherapy) of spine metastases. Transition probabilities for the model, including the risks of mortality and functional deterioration, were obtained from secondary and our institutional data. Willingness to pay thresholds were prespecified at $100,000 and $150,000. The analyses were censored after 5‐year simulation from a health system perspective and discounted outcomes at 3% per year. Sensitivity analyses were conducted to test the robustness of the study design.ResultsThe incremental cost‐effectiveness ratios were $140,907 per QALY for patients with a 3‐month survival probability >50%, $3,178,510 per QALY for patients with a 3‐month survival probability <50%, and $168,385 per QALY for patients with independent ambulatory and 3‐month survival probability >50%.ConclusionsThis study emphasizes the need to choose patients carefully and estimate preoperative survival for those with spinal metastases. In addition to reaffirming previous research regarding the influence of ambulatory status on cost‐effectiveness, our study goes a step further by highlighting that operative intervention with postoperative radiotherapy could be more cost‐effective than radiotherapy alone for patients with a better survival outlook. Accurate survival prediction tools and larger future studies could offer more detailed insights for clinical decisions.

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Systemic considerations for the surgical treatment of spinal metastatic disease: a scoping literature review

Cited by 17 publications

References 74 publications

Prognosis after Palliative Surgery for Patients with Spinal Metastasis: Comparison of Predicted and Actual Survival

Prognosis after Palliative Surgery for Patients with Spinal Metastasis: Comparison of Predicted and Actual Survival

Perception of frailty in spinal metastatic disease: international survey of the AO Spine community

Determining patients with spinal metastases suitable for surgical intervention: A cost‐effective analysis

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