Shakil Husain, Malhotra Armaan K, Essa Ahmad, Karthikeyan Vishwathsen, Lozano Christopher S, He Yingshi, Badhiwala Jetan H, Sahgal Arjun, Dea Nicolas, Fehlings Michael G, Kiss Alexander, Witiw Christopher D, Wilson Jefferson R, Redelmeier Donald A
Division of Neurosurgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, 149 College Street, 5th Floor Stewart Building, Toronto, ON, M5T1P5, Canada.
Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
J Neurooncol. 2025 Mar 20. doi: 10.1007/s11060-025-05014-z.
Clinically meaningful population health outcomes for patients with spinal metastases are lacking. This study quantifies and validates days at home (DAH) after treatment of spinal metastases, and investigates factors associated with this patient-centered outcome.
A population-based cohort study was conducted with the 2007-2019 Ontario Cancer Registry. Patients aged over 18 years undergoing surgery and/or radiation for a spinal metastasis were included. DAH was assessed at 3 months, 6 months (DAH-180), 1 year (DAH-365), and 2 years (DAH-730) after first treatment. Associations between DAH and primary cancer type, age, and frailty were assessed using multivariable quantile regression to estimate adjusted medians differences (aMD) in DAH. Predictive validity was determined with Spearman correlations between DAH-180 and longer-term DAH measures.
We identified 36,233 treated patients. Median DAH for patients after 3 months, 6 months, 1 year, and 2 years from treatment were 79 days, 114 days, 120 days, and 121 days, respectively. Lower home time was associated with older age (aMD: -16 days per decade increase in age), and frailty (aMD: -36). Primary cancers associated with the least DAH included gastrointestinal cancer (aMD: -162 days), lung cancer (aMD: -165 days), and melanoma (aMD: -167 days). DAH-180 demonstrated predictive validity with longer term DAH-365 (p < 0.001), and DAH-730 (p < 0.001).
These data help validate DAH as a reliable metric for patients treated for spinal metastases. Patients with older age, frailty, high health resource utilization, and primary melanoma, gastrointestinal or lung cancer were found to have the fewest DAH after treatment.
脊柱转移瘤患者缺乏具有临床意义的群体健康结局。本研究对脊柱转移瘤治疗后的居家天数（DAH）进行量化和验证，并调查与这一以患者为中心的结局相关的因素。
利用2007 - 2019年安大略癌症登记处进行了一项基于人群的队列研究。纳入年龄超过18岁、因脊柱转移瘤接受手术和/或放疗的患者。在首次治疗后的3个月、6个月（DAH - 180）、1年（DAH - 365）和2年（DAH - 730）评估DAH。使用多变量分位数回归评估DAH与原发癌类型、年龄和虚弱之间的关联，以估计DAH调整后的中位数差异（aMD）。通过DAH - 180与长期DAH测量值之间的Spearman相关性确定预测效度。
我们确定了36233例接受治疗的患者。治疗后3个月、6个月、1年和2年患者的DAH中位数分别为79天、114天、120天和121天。居家时间较短与年龄较大（aMD：年龄每增加十岁减少16天）和虚弱（aMD： - 36）相关。与最少DAH相关的原发癌包括胃肠道癌（aMD： - 162天）、肺癌（aMD： - 165天）和黑色素瘤（aMD： - 167天）。DAH - 180对长期的DAH - 365（p < 0.001）和DAH - 730（p < 0.001）具有预测效度。
这些数据有助于验证DAH作为脊柱转移瘤治疗患者的可靠指标。发现年龄较大、虚弱、健康资源利用率高以及原发黑色素瘤、胃肠道或肺癌患者治疗后的DAH最少。
