Remaining Systemic Treatment Options: A Valuable Predictor of Survival and Functional Outcomes after Surgical Treatment for Spinal Metastasis

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Abstract

Objectives: To evaluate survival and functional outcomes in surgically-treated spinal metastasis patients and to identify the prognostic value of the remaining options for systemic treatment. Methods: The current study reviewed 100 consecutive patients who received surgery for spinal metastasis in a single center from March 2012 to June 2016. The decision for surgery had been made in a weekly multidisciplinary tumor board after considering multiple factors. Among these factors, those associated with the functional outcome were identified using crosstab and logistic regression analyses. Survival analysis applying the Kaplan–Meier curve and the Cox proportional hazards model was used to identify factors associated with improved survival. Results: Of the 100 patients, there were 62 men and 38 women, with a mean age of 60.4 years at the time of surgery. The median postoperative survival of the whole cohort was 16.2 months (95% confidence interval: 10.1–22.3). When patients were stratified by the functional outcome, a significantly large proportion of patients with good functional outcome (Eastern Cooperative Oncology Group performance status better than 3) had an available option for systemic treatment at the time of surgery (P < 0.001, Pearson χ2-test). Logistic regression analysis found that the presence of remaining options for systemic treatment at the time of decision-making for surgery was associated with improved postoperative functional performance status (P = 0.004, odds ratio = 7.59). Survival analysis also found that the availability of remaining options for systemic treatment was associated with improved survival (P = 0.001, hazard ratio = 0.22). This finding was statistically more significant in a group of patients with a low revised Tokuhashi score of 0 to 8 (P < 0.001) when compared to the group of patients with a high revised Tokuhashi score of 9 to 15 (P = 0.082). Conclusions: Availability of remaining options for systemic treatment is an important factor to consider when deciding on surgical treatment for spinal metastasis.

Original languageEnglish
Pages (from-to)552-559
Number of pages8
JournalOrthopaedic Surgery
Volume11
Issue number4
DOIs
StatePublished - 1 Jan 2019
Externally publishedYes

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Neoplasm Metastasis
Survival
Survival Analysis
Therapeutics
Logistic Models
Regression Analysis
Proportional Hazards Models
Decision Making
Odds Ratio
Confidence Intervals
Neoplasms

Keywords

  • Chemoradiotherapy
  • Neoplasm metastasis
  • Performance status
  • Proportional hazards model
  • Survival

Cite this

@article{ef32869afe5c45e6a0a2bd1aa26a9a74,
title = "Remaining Systemic Treatment Options: A Valuable Predictor of Survival and Functional Outcomes after Surgical Treatment for Spinal Metastasis",
abstract = "Objectives: To evaluate survival and functional outcomes in surgically-treated spinal metastasis patients and to identify the prognostic value of the remaining options for systemic treatment. Methods: The current study reviewed 100 consecutive patients who received surgery for spinal metastasis in a single center from March 2012 to June 2016. The decision for surgery had been made in a weekly multidisciplinary tumor board after considering multiple factors. Among these factors, those associated with the functional outcome were identified using crosstab and logistic regression analyses. Survival analysis applying the Kaplan–Meier curve and the Cox proportional hazards model was used to identify factors associated with improved survival. Results: Of the 100 patients, there were 62 men and 38 women, with a mean age of 60.4 years at the time of surgery. The median postoperative survival of the whole cohort was 16.2 months (95{\%} confidence interval: 10.1–22.3). When patients were stratified by the functional outcome, a significantly large proportion of patients with good functional outcome (Eastern Cooperative Oncology Group performance status better than 3) had an available option for systemic treatment at the time of surgery (P < 0.001, Pearson χ2-test). Logistic regression analysis found that the presence of remaining options for systemic treatment at the time of decision-making for surgery was associated with improved postoperative functional performance status (P = 0.004, odds ratio = 7.59). Survival analysis also found that the availability of remaining options for systemic treatment was associated with improved survival (P = 0.001, hazard ratio = 0.22). This finding was statistically more significant in a group of patients with a low revised Tokuhashi score of 0 to 8 (P < 0.001) when compared to the group of patients with a high revised Tokuhashi score of 9 to 15 (P = 0.082). Conclusions: Availability of remaining options for systemic treatment is an important factor to consider when deciding on surgical treatment for spinal metastasis.",
keywords = "Chemoradiotherapy, Neoplasm metastasis, Performance status, Proportional hazards model, Survival",
author = "Chang, {Sam Yeol} and Chang, {Bong Soon} and Lee, {Choon Ki} and Hyoungmin Kim",
year = "2019",
month = "1",
day = "1",
doi = "10.1111/os.12501",
language = "English",
volume = "11",
pages = "552--559",
journal = "Orthopaedic Surgery",
issn = "1757-7853",
publisher = "Blackwell Publishing Asia Pty Ltd",
number = "4",

}

TY - JOUR

T1 - Remaining Systemic Treatment Options

T2 - A Valuable Predictor of Survival and Functional Outcomes after Surgical Treatment for Spinal Metastasis

AU - Chang, Sam Yeol

AU - Chang, Bong Soon

AU - Lee, Choon Ki

AU - Kim, Hyoungmin

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objectives: To evaluate survival and functional outcomes in surgically-treated spinal metastasis patients and to identify the prognostic value of the remaining options for systemic treatment. Methods: The current study reviewed 100 consecutive patients who received surgery for spinal metastasis in a single center from March 2012 to June 2016. The decision for surgery had been made in a weekly multidisciplinary tumor board after considering multiple factors. Among these factors, those associated with the functional outcome were identified using crosstab and logistic regression analyses. Survival analysis applying the Kaplan–Meier curve and the Cox proportional hazards model was used to identify factors associated with improved survival. Results: Of the 100 patients, there were 62 men and 38 women, with a mean age of 60.4 years at the time of surgery. The median postoperative survival of the whole cohort was 16.2 months (95% confidence interval: 10.1–22.3). When patients were stratified by the functional outcome, a significantly large proportion of patients with good functional outcome (Eastern Cooperative Oncology Group performance status better than 3) had an available option for systemic treatment at the time of surgery (P < 0.001, Pearson χ2-test). Logistic regression analysis found that the presence of remaining options for systemic treatment at the time of decision-making for surgery was associated with improved postoperative functional performance status (P = 0.004, odds ratio = 7.59). Survival analysis also found that the availability of remaining options for systemic treatment was associated with improved survival (P = 0.001, hazard ratio = 0.22). This finding was statistically more significant in a group of patients with a low revised Tokuhashi score of 0 to 8 (P < 0.001) when compared to the group of patients with a high revised Tokuhashi score of 9 to 15 (P = 0.082). Conclusions: Availability of remaining options for systemic treatment is an important factor to consider when deciding on surgical treatment for spinal metastasis.

AB - Objectives: To evaluate survival and functional outcomes in surgically-treated spinal metastasis patients and to identify the prognostic value of the remaining options for systemic treatment. Methods: The current study reviewed 100 consecutive patients who received surgery for spinal metastasis in a single center from March 2012 to June 2016. The decision for surgery had been made in a weekly multidisciplinary tumor board after considering multiple factors. Among these factors, those associated with the functional outcome were identified using crosstab and logistic regression analyses. Survival analysis applying the Kaplan–Meier curve and the Cox proportional hazards model was used to identify factors associated with improved survival. Results: Of the 100 patients, there were 62 men and 38 women, with a mean age of 60.4 years at the time of surgery. The median postoperative survival of the whole cohort was 16.2 months (95% confidence interval: 10.1–22.3). When patients were stratified by the functional outcome, a significantly large proportion of patients with good functional outcome (Eastern Cooperative Oncology Group performance status better than 3) had an available option for systemic treatment at the time of surgery (P < 0.001, Pearson χ2-test). Logistic regression analysis found that the presence of remaining options for systemic treatment at the time of decision-making for surgery was associated with improved postoperative functional performance status (P = 0.004, odds ratio = 7.59). Survival analysis also found that the availability of remaining options for systemic treatment was associated with improved survival (P = 0.001, hazard ratio = 0.22). This finding was statistically more significant in a group of patients with a low revised Tokuhashi score of 0 to 8 (P < 0.001) when compared to the group of patients with a high revised Tokuhashi score of 9 to 15 (P = 0.082). Conclusions: Availability of remaining options for systemic treatment is an important factor to consider when deciding on surgical treatment for spinal metastasis.

KW - Chemoradiotherapy

KW - Neoplasm metastasis

KW - Performance status

KW - Proportional hazards model

KW - Survival

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U2 - 10.1111/os.12501

DO - 10.1111/os.12501

M3 - Article

C2 - 31419073

AN - SCOPUS:85070746948

VL - 11

SP - 552

EP - 559

JO - Orthopaedic Surgery

JF - Orthopaedic Surgery

SN - 1757-7853

IS - 4

ER -