Ryvlin Jessica, Hamad Mousa K, Langro Justin, Wang Benjamin, Patel Pavan, De la Garza Ramos Rafael, Murthy Saikiran G, Gelfand Yaroslav, Yassari Reza
1Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx; and.
2Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.
J Neurosurg Spine. 2023 Mar 10:1-9. doi: 10.3171/2023.1.SPINE221021.
Lymphopenia is often seen in advanced metastatic disease and has been associated with poor postoperative outcomes. Limited research has been done to validate this metric in patients with spinal metastases. The objective of this study was to evaluate the capability of preoperative lymphopenia to predict 30-day mortality, overall survival (OS), and major complications in patients undergoing surgery for metastatic spine tumors.
A total of 153 patients who underwent surgery for metastatic spine tumor between 2012 and 2022 and met the inclusion criteria were examined. Electronic medical record chart review was conducted to obtain patient demographics, comorbidities, preoperative laboratory values, survival time, and postoperative complications. Preoperative lymphopenia was defined as < 1.0 K/μL based on the institution's laboratory cutoff value and within 30 days prior to surgery. The primary outcome was 30-day mortality. Secondary outcomes were OS up to 2 years and 30-day postoperative major complications. Outcomes were assessed with logistic regression. Survival analyses were done using the Kaplan-Meier method with log-rank test and Cox regression. Receiver operating characteristic curves were plotted to classify the predictive ability of lymphocyte count as a continuous variable on outcome measures.
Lymphopenia was identified in 47% of patients (72 of 153). The overall 30-day mortality rate was 9% (13 of 153). In logistic regression analysis, lymphopenia was not associated with 30-day mortality (OR 1.35, 95% CI 0.43-4.21; p = 0.609). The mean OS in this sample was 15.6 months (95% CI 13.9-17.3 months), with no significant difference between patients with lymphopenia and those with no lymphopenia (p = 0.157). Cox regression analysis did not show an association between lymphopenia and survival (HR 1.44, 95% CI 0.87-2.39; p = 0.161). The major complication rate was 26% (39 of 153). In univariable logistic regression analysis, lymphopenia was not associated with the development of a major complication (OR 1.44, 95% CI 0.70-3.00; p = 0.326). Finally, receiver operating characteristic curves generated poor discrimination between lymphocyte count and all outcomes, including 30-day mortality (area under the curve 0.600, p = 0.232).
This study does not support prior research that had shown an independent association between low preoperative lymphocyte level and poor postoperative outcomes following surgery for metastatic spine tumors. Although lymphopenia may be used to predict outcomes in other tumor-related surgeries, this metric may not hold a similar predictive capability in the population undergoing surgery for metastatic spine tumors. Further research into reliable prognostic tools is needed.
淋巴细胞减少常见于晚期转移性疾病，且与术后不良结局相关。在脊柱转移瘤患者中，为验证这一指标所做的研究有限。本研究的目的是评估术前淋巴细胞减少对接受转移性脊柱肿瘤手术患者30天死亡率、总生存期（OS）和主要并发症的预测能力。
对2012年至2022年间接受转移性脊柱肿瘤手术且符合纳入标准的153例患者进行了检查。通过电子病历图表回顾获取患者人口统计学信息、合并症、术前实验室值、生存时间和术后并发症。根据机构实验室临界值，术前淋巴细胞减少定义为手术前30天内淋巴细胞计数<1.0 K/μL。主要结局是30天死亡率。次要结局是长达2年的总生存期和术后30天主要并发症。通过逻辑回归评估结局。使用Kaplan-Meier方法和对数秩检验以及Cox回归进行生存分析。绘制受试者工作特征曲线，以将淋巴细胞计数作为连续变量对结局指标的预测能力进行分类。
47%的患者（153例中的72例）存在淋巴细胞减少。总体30天死亡率为9%（153例中的13例）。在逻辑回归分析中，淋巴细胞减少与30天死亡率无关（比值比1.35，95%置信区间0.43 - 4.21；p = 0.609）。该样本的平均总生存期为15.6个月（95%置信区间13.9 - 17.3个月），淋巴细胞减少患者与无淋巴细胞减少患者之间无显著差异（p = 0.157）。Cox回归分析未显示淋巴细胞减少与生存之间存在关联（风险比1.44，95%置信区间0.87 - 2.39；p = 0.161）。主要并发症发生率为26%（153例中的39例）。在单变量逻辑回归分析中，淋巴细胞减少与主要并发症的发生无关（比值比1.44，95%置信区间0.70 - 3.00；p = 0.326）。最后，受试者工作特征曲线在淋巴细胞计数与所有结局（包括30天死亡率）之间的区分能力较差（曲线下面积0.600，p = 0.232）。
本研究不支持先前的研究结果，即术前淋巴细胞水平低与转移性脊柱肿瘤手术后不良术后结局之间存在独立关联。尽管淋巴细胞减少可用于预测其他肿瘤相关手术的结局，但该指标在接受转移性脊柱肿瘤手术的人群中可能不具有类似的预测能力。需要进一步研究可靠的预后工具。
