TY - JOUR
T1 - Visceral fat volume from standard preoperative ct is an independent predictor of short-term survival in patients undergoing surgery for metastatic spine disease
AU - Pennington, Zach
AU - Pielkenrood, Bart
AU - Ahmed, A. Karim
AU - Goodwin, C. Rory
AU - Verlaan, Jorrit Jan
AU - Sciubba, Daniel M.
N1 - Funding Information:
C.R.G.: a United Negro College Fund Merck postdoctoral fellow and received an award from the Burroughs Wellcome Fund and the Johns Hopkins Neurosurgery Pain Research Institute. D.M.S.: consultant for DePuy-Synthes, Medtronic, Stryker, K2M, Globus, and Orthofix. The remaining authors declare no conflict of interest.
Publisher Copyright:
© 2019 Wolters Kluwer Health Inc.
PY - 2019/7/1
Y1 - 2019/7/1
N2 - STUDY DESIGN: This is a retrospective cohort.OBJECTIVE: Determine the relationship of body morphometry to postoperative survival in patients with vertebral metastases.SUMMARY OF BACKGROUND DATA: Most operations for vertebral metastases aim for palliation not cure, yet expected patient survival heavily influences treatment plans. We seek to demonstrate that preoperative fat and muscle volumes on standard-of-care computed tomography (CT) are independent predictors of survival after surgery for vertebral metastases.MATERIALS AND METHODS: Included data were preoperative neurological status, adjuvant treatments, CT-assessed body composition, health comorbidities, details of oncologic disease, and Tomita and Tokuhashi scores. Body composition-visceral fat area, subcutaneous fat area, and total muscle area-were assessed on preoperative L3/4 CT slice with Image J software. Multivariable logistic regressions were used to determine independent predictors of 3-, 6-, and 12-month survival.RESULTS: We included 75 patients (median age, 57, 57.3% male, 66.7% white) with the most common primary lesions being lung (17.3%), prostate (14.7%), colorectal (12.0%), breast (10.7%), and kidney (9.3%). The only independent predictor of 3-month survival was visceral fat area [95% confidence interval (CI): 1.02-1.23 per 1000 mm; P=0.02]. Independent predictors of survival at 6 months were body mass index (95% CI: 1.04-1.35 per kg/m; P=0.009), Karnofsky performance status (95% CI: 1.00-1.15; P<0.05), modified Charlson Comorbidity Index (95% CI: 1.11-7.91; P=0.03), and postoperative chemotherapy use (95% CI: 1.13-4.71; P=0.02). Independent predictors of 12-month survival were kidney primary pathology (95% CI: 0.00-0.00; P<0.01), body mass index (95% CI: 1.03-1.39 per kg/m; P=0.02), and being ambulatory preoperatively (95% CI: 1.28-17.06; P=0.02).CONCLUSIONS: Visceral fat mass was an independent, positive predictor of short-term postoperative survival in patients treated for vertebral metastases. As a result, we believe that the prognostic accuracy of current predictors may be improved by the addition of visceral fat volume as a risk factor.
AB - STUDY DESIGN: This is a retrospective cohort.OBJECTIVE: Determine the relationship of body morphometry to postoperative survival in patients with vertebral metastases.SUMMARY OF BACKGROUND DATA: Most operations for vertebral metastases aim for palliation not cure, yet expected patient survival heavily influences treatment plans. We seek to demonstrate that preoperative fat and muscle volumes on standard-of-care computed tomography (CT) are independent predictors of survival after surgery for vertebral metastases.MATERIALS AND METHODS: Included data were preoperative neurological status, adjuvant treatments, CT-assessed body composition, health comorbidities, details of oncologic disease, and Tomita and Tokuhashi scores. Body composition-visceral fat area, subcutaneous fat area, and total muscle area-were assessed on preoperative L3/4 CT slice with Image J software. Multivariable logistic regressions were used to determine independent predictors of 3-, 6-, and 12-month survival.RESULTS: We included 75 patients (median age, 57, 57.3% male, 66.7% white) with the most common primary lesions being lung (17.3%), prostate (14.7%), colorectal (12.0%), breast (10.7%), and kidney (9.3%). The only independent predictor of 3-month survival was visceral fat area [95% confidence interval (CI): 1.02-1.23 per 1000 mm; P=0.02]. Independent predictors of survival at 6 months were body mass index (95% CI: 1.04-1.35 per kg/m; P=0.009), Karnofsky performance status (95% CI: 1.00-1.15; P<0.05), modified Charlson Comorbidity Index (95% CI: 1.11-7.91; P=0.03), and postoperative chemotherapy use (95% CI: 1.13-4.71; P=0.02). Independent predictors of 12-month survival were kidney primary pathology (95% CI: 0.00-0.00; P<0.01), body mass index (95% CI: 1.03-1.39 per kg/m; P=0.02), and being ambulatory preoperatively (95% CI: 1.28-17.06; P=0.02).CONCLUSIONS: Visceral fat mass was an independent, positive predictor of short-term postoperative survival in patients treated for vertebral metastases. As a result, we believe that the prognostic accuracy of current predictors may be improved by the addition of visceral fat volume as a risk factor.
KW - Female
KW - Humans
KW - Intra-Abdominal Fat/pathology
KW - Linear Models
KW - Male
KW - Middle Aged
KW - Multivariate Analysis
KW - Preoperative Care
KW - ROC Curve
KW - Spinal Neoplasms/diagnostic imaging
KW - Survival Analysis
KW - Tomography, X-Ray Computed
UR - http://www.scopus.com/inward/record.url?scp=85061377327&partnerID=8YFLogxK
U2 - 10.1097/BSD.0000000000000784
DO - 10.1097/BSD.0000000000000784
M3 - Article
C2 - 30730429
AN - SCOPUS:85061377327
SN - 2380-0186
VL - 32
SP - E303-E310
JO - Clinical Spine Surgery
JF - Clinical Spine Surgery
IS - 6
ER -