University Hospital Cologne, Department of Orthopedic Surgery and Traumatology, Cologne, Germany.
University Hospital Cologne, Department of Orthopedic Surgery and Traumatology, Cologne, Germany.
Surg Oncol. 2024 Feb;52:102029. doi: 10.1016/j.suronc.2023.102029. Epub 2023 Dec 16.
While predictors for postoperative survival in spine tumour patients have been identified, there is limited evidence for predictors of postoperative Quality of Life (QoL), pain and functional outcome.
One hundred and fifty-three consecutive patients, who had undergone surgery for symptomatic spinal metastases between June 2016 and April 2019, were interviewed preoperatively and during follow-ups at three, six and 12 months using the EQ-5D-3L, COMI, and ODI questionnaires. Differences in means exceeding the specific Minimal Clinically Important Difference (MCID) values were considered clinically significant.
Thirty-three percent of the patients were reported dead after 12 months. Only one metastasis compared to multiple metastases has 7.9 the Odds for an improved EQ-5D-3L score at three months. No neoadjuvant metastatic irradiation has 6.8 the Odds for the improvement at that time against performed radiation. A preoperative ODI score between 50.1 and 100 has 22.0 times the odds compared to the range from 0 to 50 for an improved EQ-5D-3L after three months, and 12.5 times the odds in favour of improved COMI after three months, and 13.6 times the odds for improvement of ODI at the three-month follow-up. A preoperative COMI score ranging from 5.0 to 10 has 21 times the odds of a COMI between 0 and 5 for an improved EQ-5D-3L score and 11 times the odds for an improved ODI after 12 months. Other predictors showed no statistically significant improvement.
An improvement in QoL, pain and spinal function after 12 months can be predicted by a subjective preoperative poor health condition. Impaired spinal function before surgery, a singular metastasis and no previous irradiation is predictive of improved spinal function and quality of life three months after surgery.
虽然已经确定了脊柱肿瘤患者术后生存的预测因素，但对于术后生活质量（QoL）、疼痛和功能结果的预测因素的证据有限。
153 例连续患者于 2016 年 6 月至 2019 年 4 月期间因脊柱转移瘤症状而行手术治疗，分别于术前和术后 3、6、12 个月使用 EQ-5D-3L、COMI 和 ODI 问卷进行访谈。均值差异超过特定的最小临床重要差异（MCID）值被认为具有临床意义。
12 个月后，33%的患者死亡。与多发转移相比，单发转移的患者在三个月时改善 EQ-5D-3L 评分的几率为 7.9 倍。未行新辅助转移放疗的患者改善的几率为 6.8 倍。术前 ODI 评分在 50.1 至 100 之间的患者，与 ODI 评分在 0 至 50 之间的患者相比，三个月后 EQ-5D-3L 评分改善的几率为 22.0 倍，三个月后 COMI 改善的几率为 12.5 倍，三个月后 ODI 改善的几率为 13.6 倍。术前 COMI 评分在 5.0 至 10 之间的患者，与 COMI 评分在 0 至 5 之间的患者相比，EQ-5D-3L 评分改善的几率为 21.0 倍，ODI 评分改善的几率为 11.0 倍。其他预测因素无统计学意义。
术前健康状况较差可预测术后 12 个月 QoL、疼痛和脊柱功能的改善。术前脊柱功能受损、单发转移和无放疗是术后三个月脊柱功能和生活质量改善的预测因素。
