Iinuma Masahiro, Akazawa Tsutomu, Torii Yoshiaki, Ueno Jun, Kuroya Shingo, Yoshida Atsuhiro, Tomochika Ken, Hideshima Takahiro, Haraguchi Naoki, Niki Hisateru
Department of Orthopaedic Surgery, St. Marianna University, Yokohama Seibu Hospital, Yokohama, JPN.
Department of Orthopaedic Surgery, St. Marianna University, Kawasaki, JPN.
Cureus. 2023 Jun 15;15(6):e40451. doi: 10.7759/cureus.40451. eCollection 2023 Jun.
Background Preoperative and postoperative nutritional statuses are reported to influence the outcomes and complications of multidisciplinary treatment, including patient survival. However, a causal relationship between nutritional status and survival following spinal surgery has not been demonstrated in patients with metastatic spinal tumors. The present study was, therefore, designed to evaluate the correlation between the nutritional status and survival following spinal surgery in patients with metastatic spinal tumors. Methods Nutritional status was evaluated using the Japanese version of the modified Glasgow prognostic score (JmGPS), C-reactive protein-to-albumin ratio (CAR), prognostic nutrition index (PNI), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), which were calculated from the results of preoperative laboratory tests. The survival period was defined as the interval between the day preoperative data were obtained and the day of death. Results Data from 57 of 113 consecutive surgeries were retrieved. The CAR, JmGPS, and PNI were significantly correlated with the survival period (CAR, r = -0.576, P < 0.01; JmGPS, r = -0.537, P < 0.01; PNI, r = 0.316, P = 0.02). Furthermore, patients with 0 points on the JmGPS had significantly longer survival. Using receiver operating characteristic curves, CAR cutoffs of ≥0.880 and ≤0.220 were found to be optimal in predicting the 90- and 180-day postoperative survival, respectively. Conclusions The findings of the present study indicate that preoperative assessment of the JmGPS, CAR, and PNI has utility in estimating nutritional status and predicting survival following spinal surgery in patients with metastatic spinal tumors.
背景 据报道，术前和术后营养状况会影响多学科治疗的结果和并发症，包括患者的生存率。然而，转移性脊柱肿瘤患者的营养状况与脊柱手术后生存率之间的因果关系尚未得到证实。因此，本研究旨在评估转移性脊柱肿瘤患者脊柱手术后营养状况与生存率之间的相关性。方法 使用日本版改良格拉斯哥预后评分（JmGPS）、C反应蛋白与白蛋白比值（CAR）、预后营养指数（PNI）、中性粒细胞与淋巴细胞比值（NLR）以及血小板与淋巴细胞比值（PLR）评估营养状况，这些指标根据术前实验室检查结果计算得出。生存期定义为获取术前数据之日至死亡之日的时间间隔。结果 检索了连续113例手术中57例的数据。CAR、JmGPS和PNI与生存期显著相关（CAR，r = -0.576，P < 0.01；JmGPS，r = -0.537，P < 0.01；PNI，r = 0.316，P = 0.02）。此外，JmGPS评分为0分的患者生存期明显更长。使用受试者工作特征曲线发现，CAR临界值≥0.880和≤0.220分别最适合预测术后90天和180天的生存率。结论 本研究结果表明，术前评估JmGPS、CAR和PNI有助于评估转移性脊柱肿瘤患者脊柱手术后的营养状况并预测生存率。
