{"title":"Risk Factors for Early 3-Month Postoperative Mortality in Metastatic Spinal Tumor Surgery: A JASA Multicenter Prospective Study.","authors":"Takaaki Uto, Satoshi Kato, Noriaki Yokogawa, Takaki Shimizu, Satoru Demura, Yuki Shiratani, Akinobu Suzuki, Koji Tamai, Kenichiro Kakutani, Yutaro Kanda, Hiroyuki Tominaga, Ichiro Kawamura, Masayuki Ishihara, Masaaki Paku, Toru Funayama, Kousei Miura, Eiki Shirasawa, Hirokazu Inoue, Atsushi Kimura, Takuya Iimura, Hiroshi Moridaira, Koji Akeda, Norihiko Takegami, Kazuo Nakanishi, Hirokatsu Sawada, Koji Matsumoto, Masahiro Funaba, Hidenori Suzuki, Hideaki Nakajima, Tsutomu Oshigiri, Takashi Hirai, Bungo Otsuki, Kazu Kobayakawa, Haruki Funao, Koji Uotani, Shinji Tanishima, Koichi Sairyo, Ko Hashimoto, Chizuo Iwai, Shoji Seki, Masashi Miyazaki, Kazuyuki Watanabe, Toshio Nakamae, Takashi Kaito, Hiroaki Nakashima, Narihito Nagoshi, Shiro Imagama, Kota Watanabe, Gen Inoue, Takeo Furuya","doi":"10.1097/BRS.0000000000005359","DOIUrl":null,"url":null,"abstract":"<p><strong>Study design: </strong>Prospective multicenter study.</p><p><strong>Objective: </strong>To investigate risk factors for 3-month postoperative mortality in metastatic spinal tumor surgery, focusing on nutritional biomarkers and prognostic scores alongside clinical indicators.</p><p><strong>Summary of background data: </strong>Metastatic spinal tumors affect patient morbidity and mortality. Although prognostic tools exist, they have limitations, particularly in emergency situations requiring rapid assessment. Nutritional biomarkers and prognostic scores may influence outcomes, but their role in predicting early postoperative mortality after spinal tumor surgery, particularly in prospective, multicenter studies, warrants investigation.</p><p><strong>Methods: </strong>Data from 336 patients undergoing palliative surgery for metastatic spinal tumors were collected from 35 centers. The primary outcome was 3-month postoperative mortality. Univariate and multivariate logistic regression analyses with bootstrapping were performed to identify predictors of early mortality, including demographics, prognostic scores (revised Tokuhashi, Tomita, modified Glasgow Prognostic Score [mGPS], and the New England Spinal Metastasis Score [NESMS]), and nutritional biomarkers. The discriminative ability of these factors was evaluated using the receiver operating characteristic curve analysis.</p><p><strong>Results: </strong>Results: The 3-month postoperative mortality rate was 15.5%, with primary cancer progression accounting for 54% of the deaths. Multivariate analysis revealed that high mGPS (OR=1.989, P=0.008) and low preoperative performance status (PS) (OR=1.412, P=0.034) were significant independent predictors of early mortality, the Tomita score showed a trend towards significance (OR=1.234, P=0.050). The mGPS demonstrated a high discriminative ability, with an area under the curve of 0.716.</p><p><strong>Conclusion: </strong>High mGPS and low preoperative PS are significant predictors of 3-month postoperative mortality in patients undergoing surgery for metastatic spinal tumors. Incorporating the mGPS, which reflects nutritional and inflammatory status, into preoperative risk stratification is crucial for optimizing surgical decision-making.</p><p><strong>Level of evidence: </strong>2.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6000,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Spine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BRS.0000000000005359","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
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Abstract
Study design: Prospective multicenter study.
Objective: To investigate risk factors for 3-month postoperative mortality in metastatic spinal tumor surgery, focusing on nutritional biomarkers and prognostic scores alongside clinical indicators.
Summary of background data: Metastatic spinal tumors affect patient morbidity and mortality. Although prognostic tools exist, they have limitations, particularly in emergency situations requiring rapid assessment. Nutritional biomarkers and prognostic scores may influence outcomes, but their role in predicting early postoperative mortality after spinal tumor surgery, particularly in prospective, multicenter studies, warrants investigation.
Methods: Data from 336 patients undergoing palliative surgery for metastatic spinal tumors were collected from 35 centers. The primary outcome was 3-month postoperative mortality. Univariate and multivariate logistic regression analyses with bootstrapping were performed to identify predictors of early mortality, including demographics, prognostic scores (revised Tokuhashi, Tomita, modified Glasgow Prognostic Score [mGPS], and the New England Spinal Metastasis Score [NESMS]), and nutritional biomarkers. The discriminative ability of these factors was evaluated using the receiver operating characteristic curve analysis.
Results: Results: The 3-month postoperative mortality rate was 15.5%, with primary cancer progression accounting for 54% of the deaths. Multivariate analysis revealed that high mGPS (OR=1.989, P=0.008) and low preoperative performance status (PS) (OR=1.412, P=0.034) were significant independent predictors of early mortality, the Tomita score showed a trend towards significance (OR=1.234, P=0.050). The mGPS demonstrated a high discriminative ability, with an area under the curve of 0.716.
Conclusion: High mGPS and low preoperative PS are significant predictors of 3-month postoperative mortality in patients undergoing surgery for metastatic spinal tumors. Incorporating the mGPS, which reflects nutritional and inflammatory status, into preoperative risk stratification is crucial for optimizing surgical decision-making.
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Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.
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