Center for Neurosurgery, University of Cologne, Cologne , Germany.
Department of Orthopedics and Trauma Surgery, University of Cologne, Cologne , Germany.
Neurosurgery. 2024 Oct 1;95(4):770-778. doi: 10.1227/neu.0000000000002941. Epub 2024 Apr 8.
Surgical treatment is an integral component of multimodality management of metastatic spine disease but must be balanced against the risk of surgery-related morbidity and mortality, making tailored surgical counseling a clinical challenge. The aim of this study was to investigate the potential predictive value of the preoperative performance status for surgical outcome in patients with spinal metastases.
Performance status was determined using the Karnofsky Performance Scale (KPS), and surgical outcome was classified as "favorable" or "unfavorable" based on postoperative changes in neurological function and perioperative complications. The correlation between preoperative performance status and surgical outcome was assessed to determine a KPS-related performance threshold.
A total of 463 patients were included. The mean age was 63 years (range: 22-87), and the mean preoperative KPS was 70 (range: 30-100). Analysis of clinical outcome in relation to the preoperative performance status revealed a KPS threshold between 40% and 50% with a relative risk of an unfavorable outcome of 65.7% in KPS ≤40% compared with the relative chance for a favorable outcome of 77.1% in KPS ≥50%. Accordingly, we found significantly higher rates of preserved or restored ambulatory function in KPS ≥50% (85.7%) than in KPS ≤40% (48.6%; P < .001) as opposed to a significantly higher risk of perioperative mortality in KPS ≤40% (11.4%) than in KPS ≥50% (2.1%, P = .012).
Our results underline the predictive value of the KPS in metastatic spine patients for counseling and decision-making. The study suggests an overall clinical benefit of surgical treatment of spinal metastases in patients with a preoperative KPS score ≥50%, while a high risk of unfavorable outcome outweighing the potential clinical benefit from surgery is encountered in patients with a KPS score ≤40%.
手术治疗是脊柱转移瘤多模态治疗的一个重要组成部分，但必须权衡与手术相关的发病率和死亡率的风险，这使得量身定制的手术咨询成为一个临床挑战。本研究的目的是探讨术前功能状态对脊柱转移瘤患者手术结果的潜在预测价值。
使用 Karnofsky 表现量表（KPS）确定功能状态，并根据术后神经功能和围手术期并发症的变化将手术结果分类为“有利”或“不利”。评估术前功能状态与手术结果之间的相关性，以确定与 KPS 相关的功能状态阈值。
共纳入 463 例患者。平均年龄为 63 岁（范围：22-87 岁），平均术前 KPS 为 70（范围：30-100）。分析临床结果与术前功能状态的关系，发现 KPS 在 40%至 50%之间存在一个阈值，KPS≤40%的不利结局相对风险为 65.7%，而 KPS≥50%的有利结局相对机会为 77.1%。因此，我们发现 KPS≥50%的患者保留或恢复活动能力的比例明显更高（85.7%），而 KPS≤40%的患者（48.6%；P<.001）；相反，KPS≤40%的患者围手术期死亡率明显更高（11.4%），而 KPS≥50%的患者（2.1%；P=.012）。
我们的结果强调了 KPS 在脊柱转移瘤患者中的预测价值，有助于咨询和决策。该研究表明，术前 KPS 评分≥50%的脊柱转移瘤患者接受手术治疗具有总体临床获益，而 KPS 评分≤40%的患者则面临不利结局风险高，手术获益可能无法超过风险。
