TY - JOUR
T1 - Prediction of quality of life and survival after surgery for symptomatic spinal metastases
T2 - A multicenter cohort study to determine suitability for surgical treatment
AU - Choi, David
AU - Fox, Zoe
AU - Albert, Todd
AU - Arts, Mark
AU - Balabaud, Laurent
AU - Bunger, Cody
AU - Buchowski, Jacob M.
AU - Coppes, Maarten H.
AU - Depreitere, Bart
AU - Fehlings, Michael G.
AU - Harrop, James
AU - Kawahara, Norio
AU - Martin-Benlloch, Juan A.
AU - Massicotte, Eric M.
AU - Mazel, Christian
AU - Oner, Fetullah C.
AU - Peul, Wilco
AU - Quraishi, Nasir
AU - Tokuhashi, Yasuaki
AU - Tomita, Katsuro
AU - Verlaan, JJ
AU - Wang, Michael
AU - Crockard, H. Alan
PY - 2015/8/4
Y1 - 2015/8/4
N2 - BACKGROUND: Surgery for symptomatic spinal metastases aims to improve quality of
life, pain, function, and stability. Complications in the postoperative period are not
uncommon; therefore, it is important to select appropriate patients who are likely to
benefit the greatest from surgery. Previous studies have focused on predicting survival
rather than quality of life after surgery. OBJECTIVE: To determine preoperative patient characteristics that predict postoperative
quality of life and survival in patients who undergo surgery for spinal
metastases. METHODS: In a prospective cohort study of 922 patients with spinal metastases who
underwent surgery, we performed preoperative and postoperative assessment of EuroQol
EQ-5D quality of life, visual analog score for pain, Karnofsky physical functioning
score, complication rates, and survival. RESULTS: The primary tumor type, number of spinal metastases, and presence of
visceral metastases were independent predictors of survival. Predictors of quality of life
after surgery included preoperative EQ-5D (P = .002), Frankel score (P , .001), and
Karnofsky Performance Status (P , .001). CONCLUSION: Data from the largest prospective surgical series of patients with
symptomatic spinal metastases revealed that tumor type, the number of spinal
metastases, and the presence of visceral metastases are the most useful predictors of
survival and that quality of life is best predicted by preoperative Karnofsky, Frankel, and
EQ-5D scores. The Karnofsky score predicts quality of life and survival and is easy to
determine at the bedside, unlike the EQ-5D index. Karnofsky score, tumor type, and
spinal and visceral metastases should be considered the 4 most important prognostic
variables that influence patient management.
AB - BACKGROUND: Surgery for symptomatic spinal metastases aims to improve quality of
life, pain, function, and stability. Complications in the postoperative period are not
uncommon; therefore, it is important to select appropriate patients who are likely to
benefit the greatest from surgery. Previous studies have focused on predicting survival
rather than quality of life after surgery. OBJECTIVE: To determine preoperative patient characteristics that predict postoperative
quality of life and survival in patients who undergo surgery for spinal
metastases. METHODS: In a prospective cohort study of 922 patients with spinal metastases who
underwent surgery, we performed preoperative and postoperative assessment of EuroQol
EQ-5D quality of life, visual analog score for pain, Karnofsky physical functioning
score, complication rates, and survival. RESULTS: The primary tumor type, number of spinal metastases, and presence of
visceral metastases were independent predictors of survival. Predictors of quality of life
after surgery included preoperative EQ-5D (P = .002), Frankel score (P , .001), and
Karnofsky Performance Status (P , .001). CONCLUSION: Data from the largest prospective surgical series of patients with
symptomatic spinal metastases revealed that tumor type, the number of spinal
metastases, and the presence of visceral metastases are the most useful predictors of
survival and that quality of life is best predicted by preoperative Karnofsky, Frankel, and
EQ-5D scores. The Karnofsky score predicts quality of life and survival and is easy to
determine at the bedside, unlike the EQ-5D index. Karnofsky score, tumor type, and
spinal and visceral metastases should be considered the 4 most important prognostic
variables that influence patient management.
KW - Prognosis
KW - Quality of life
KW - Spinal metastases
KW - Surgery
KW - Survival
UR - http://www.scopus.com/inward/record.url?scp=84944675260&partnerID=8YFLogxK
U2 - 10.1227/NEU.0000000000000907
DO - 10.1227/NEU.0000000000000907
M3 - Article
C2 - 26204361
AN - SCOPUS:84944675260
SN - 0148-396X
VL - 77
SP - 698
EP - 708
JO - Neurosurgery
JF - Neurosurgery
IS - 5
ER -