Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan.
Johns Hopkins University, Baltimore, Maryland.
Neurosurgery. 2020 Oct 15;87(5):1025-1036. doi: 10.1093/neuros/nyaa245.
Novel methods in predicting survival in patients with spinal metastases may help guide clinical decision-making and stratify treatments regarding surgery vs palliative care.
To evaluate whether the frailty/sarcopenia paradigm is predictive of survival and morbidity in patients undergoing surgery for spinal metastasis.
A total of 271 patients from 4 tertiary care centers who had undergone surgery for spinal metastasis were identified. Frailty/sarcopenia was defined by psoas muscle size. Survival hazard ratios were calculated using multivariate analysis, with variables from demographic, functional, oncological, and surgical factors. Secondary outcomes included improvement of neurological function and postoperative morbidity.
Patients in the smallest psoas tertile had shorter overall survival compared to the middle and largest tertile. Psoas size (PS) predicted overall mortality more strongly than Tokuhashi score, Tomita score, and Karnofsky Performance Status (KPS). PS predicted 90-d mortality more strongly than Tokuhashi score, Tomita score, and KPS. Patients with a larger PS were more likely to have an improvement in deficit compared to the middle tertile. PS was not predictive of 30-d morbidity.
In patients undergoing surgery for spine metastases, PS as a surrogate for frailty/sarcopenia predicts 90-d and overall mortality, independent of demographic, functional, oncological, and surgical characteristics. The frailty/sarcopenia paradigm is a stronger predictor of survival at these time points than other standards. PS can be used in clinical decision-making to select which patients with metastatic spine tumors are appropriate surgical candidates.
新型方法预测脊柱转移瘤患者的生存情况，可能有助于指导临床决策，并对手术与姑息治疗进行分层。
评估虚弱/肌少症模式是否可预测脊柱转移瘤患者手术的生存和发病率。
从 4 个三级护理中心中确定了 271 例接受脊柱转移瘤手术的患者。通过腰大肌大小来定义虚弱/肌少症。使用多变量分析计算生存风险比，纳入来自人口统计学、功能、肿瘤学和手术因素的变量。次要结局包括神经功能改善和术后发病率。
与中值和最大值三分位相比，最小三分位的患者总体生存率更短。腰大肌大小（PS）比 Tokuhashi 评分、Tomita 评分和 Karnofsky 表现状态（KPS）更能预测总体死亡率。PS 比 Tokuhashi 评分、Tomita 评分和 KPS 更能预测 90d 死亡率。与中值三分位相比，PS 较大的患者更有可能改善缺陷。PS 与 30d 发病率无关。
在接受脊柱转移瘤手术的患者中，PS 作为虚弱/肌少症的替代指标，可预测 90d 和总死亡率，独立于人口统计学、功能、肿瘤学和手术特征。虚弱/肌少症模式在这些时间点是比其他标准更强的生存预测因素。PS 可用于临床决策，以选择哪些患有转移性脊柱肿瘤的患者适合手术。
