标准术前CT测量的内脏脂肪体积是转移性脊柱疾病手术患者短期生存的独立预测因素。

Visceral Fat Volume From Standard Preoperative CT is an Independent Predictor of Short-term Survival in Patients Undergoing Surgery for Metastatic Spine Disease.

作者信息

Pennington Zach, Pielkenrood Bart, Ahmed A Karim, Goodwin C Rory, Verlaan Jorrit-Jan, Sciubba Daniel M

机构信息

Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD.

Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands.

出版信息

Clin Spine Surg. 2019 Jul;32(6):E303-E310. doi: 10.1097/BSD.0000000000000784.

DOI:10.1097/BSD.0000000000000784

PMID:30730429

Abstract

STUDY DESIGN

This is a retrospective cohort.

OBJECTIVE

Determine the relationship of body morphometry to postoperative survival in patients with vertebral metastases.

SUMMARY OF BACKGROUND DATA

Most operations for vertebral metastases aim for palliation not cure, yet expected patient survival heavily influences treatment plans. We seek to demonstrate that preoperative fat and muscle volumes on standard-of-care computed tomography (CT) are independent predictors of survival after surgery for vertebral metastases.

MATERIALS AND METHODS

Included data were preoperative neurological status, adjuvant treatments, CT-assessed body composition, health comorbidities, details of oncologic disease, and Tomita and Tokuhashi scores. Body composition-visceral fat area, subcutaneous fat area, and total muscle area-were assessed on preoperative L3/4 CT slice with Image J software. Multivariable logistic regressions were used to determine independent predictors of 3-, 6-, and 12-month survival.

RESULTS

We included 75 patients (median age, 57, 57.3% male, 66.7% white) with the most common primary lesions being lung (17.3%), prostate (14.7%), colorectal (12.0%), breast (10.7%), and kidney (9.3%). The only independent predictor of 3-month survival was visceral fat area [95% confidence interval (CI): 1.02-1.23 per 1000 mm; P=0.02]. Independent predictors of survival at 6 months were body mass index (95% CI: 1.04-1.35 per kg/m; P=0.009), Karnofsky performance status (95% CI: 1.00-1.15; P<0.05), modified Charlson Comorbidity Index (95% CI: 1.11-7.91; P=0.03), and postoperative chemotherapy use (95% CI: 1.13-4.71; P=0.02). Independent predictors of 12-month survival were kidney primary pathology (95% CI: 0.00-0.00; P<0.01), body mass index (95% CI: 1.03-1.39 per kg/m; P=0.02), and being ambulatory preoperatively (95% CI: 1.28-17.06; P=0.02).

CONCLUSIONS

Visceral fat mass was an independent, positive predictor of short-term postoperative survival in patients treated for vertebral metastases. As a result, we believe that the prognostic accuracy of current predictors may be improved by the addition of visceral fat volume as a risk factor.

摘要

研究设计

这是一项回顾性队列研究。

目的

确定椎体转移瘤患者身体形态测量指标与术后生存率的关系。

背景数据总结

大多数椎体转移瘤手术旨在缓解症状而非治愈，然而患者的预期生存情况对治疗方案有重大影响。我们试图证明，在标准护理计算机断层扫描（CT）上测得的术前脂肪和肌肉体积是椎体转移瘤手术后生存的独立预测因素。

材料与方法

纳入的数据包括术前神经功能状态、辅助治疗、CT评估的身体成分、健康合并症、肿瘤疾病细节以及富田和德桥评分。使用Image J软件在术前L3/4 CT切片上评估身体成分——内脏脂肪面积、皮下脂肪面积和总肌肉面积。采用多变量逻辑回归分析确定3个月、6个月和12个月生存率的独立预测因素。

结果

我们纳入了75例患者（中位年龄57岁，男性占57.3%，白人占66.7%），最常见的原发肿瘤为肺癌（17.3%）、前列腺癌（14.7%）、结直肠癌（12.0%）、乳腺癌（10.7%）和肾癌（9.3%）。3个月生存率的唯一独立预测因素是内脏脂肪面积[95%置信区间（CI）：每1000 mm²为1.02 - 1.23；P = 0.02]。6个月生存率的独立预测因素包括体重指数（95% CI：每kg/m²为1.04 - 1.35；P = 0.009）、卡氏功能状态评分（95% CI：1.00 - 1.15；P < 0.05）、改良查尔森合并症指数（95% CI：1.11 - 7.91；P = 0.03）以及术后化疗的使用情况（95% CI：1.13 - 4.71；P = 0.02）。12个月生存率的独立预测因素包括肾脏原发病理情况（95% CI：0.00 - 0.00；P < 0.01）、体重指数（95% CI：每kg/m²为1.03 - 1.39；P = 0.02）以及术前可行走状态（95% CI：1.28 - 17.06；P = 0.02）。