Journal article
Predictors of Survival Following Emergent Surgical Decompression for Acutely Presenting Spinal Metastasis
World neurosurgery, Vol.179, pp.e39-e45
11/2023
DOI: 10.1016/j.wneu.2023.06.082
PMID: 37356480
Abstract
Metastatic spinal tumors represent 90% of spinal masses and present variably with slow progression and/or rapid symptomatic worsening. Several prognostic scoring systems have been proposed. However, patients presenting acutely and requiring emergent surgery represent a unique subset of patients with different prognostic indicators.
All cases of symptomatic spinal metastases requiring emergent surgery between 2010-2021 at our institution were retrospectively reviewed. Survival time from date of surgery to death or last follow-up was calculated. Patients were stratified based on survival for more or less than 6-months following surgery. Multivariate Logistic Regression was used to develop a model predicting probability of mortality at 6-months.
Forty-four patients satisfied inclusion criteria. Mean age at presentation was 60.4 ± 11.8 years with a median survival time of 6.5 [1.9-19.5 IQR] months. On univariate analysis, higher Tokuhashi Score, Karnofksy Performance Scale (KPS), and lower Modified McCormick Scale were significantly associated with 6-month survival (p=0.018, p<0.001, p=0.002, respectively). Preoperative ASIA Grade and SINS Score were not associated with survival. Multivariate analysis found KPS significantly correlated with survival (0.91 OR, 0.85-0.98, 95% CI, p=0.011) at 6-months and that a stepwise regression model derived from KPS and Tokuhashi Score demonstrated the highest predictive accuracy for 6-month survival (AUC=0.843, AIC=37.1, p=0.0039).
KPS and Tokuhashi Score most strongly correlated with 6-month survival in patients presenting with acutely symptomatic spinal metastases. These findings underscore the importance of baseline functional status and overall tumor burden on survival and may be useful in preoperative evaluation and surgical decision-making for acutely presenting spinal metastases.
Details
- Title: Subtitle
- Predictors of Survival Following Emergent Surgical Decompression for Acutely Presenting Spinal Metastasis
- Creators
- Anthony J Piscopo - University of IowaBrian J Park - University of IowaEli A Perez - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, 52242, USASara Ternes - Department of Epidemiology, University of Iowa, Iowa City, Iowa, 52242, USAColin Gold - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, 52242, USARyan Carnahan - University of IowaSatoshi Yamaguchi - University of IowaHiroto Kawasaki - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, 52242, USA. Electronic address: hiroto-kawasaki@uiowa.edu
- Resource Type
- Journal article
- Publication Details
- World neurosurgery, Vol.179, pp.e39-e45
- DOI
- 10.1016/j.wneu.2023.06.082
- PMID
- 37356480
- NLM abbreviation
- World Neurosurg
- eISSN
- 1878-8769
- Language
- English
- Electronic publication date
- 06/23/2023
- Date published
- 11/2023
- Academic Unit
- Epidemiology; Nursing; Injury Prevention Research Center; Neurosurgery
- Record Identifier
- 9984437559902771
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