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Introduction <p>Preoperative survival prognostication is the main factor to consider when selecting patients who will benefit from metastatic spine surgery. Since patients’ selection for surgery is not fully standardized, we aim to identify clinical, oncological and biological markers associated with poor post-operative prognosis.</p> Methods <p>A retrospective analysis was conducted in 105 patients referred to a specialized center for surgery of spinal metastasis between October 2020 and January 2022. Detailed clinical and biological variables were collected. Univariate and multivariate analyses were performed to assess overall survival.</p> Results <p>Among the 105 patients included, One-third died within six months. Multivariate survival analysis identified age, Karnofsky score, hyperalgesia and C-reactive protein (CRP) as independently associated with shorter survival. Patients with CRP values above 100&#xa0;mg/L had a 57% mortality rate at three months. Hyperalgesic patients had a higher mortality rate at three months (<i>p</i> = 0.047), and preoperative use of strong opioids was significantly associated with lower rates of pain relief (<i>p</i> = 0.042). However, pre-operative neurological deficits did not significantly impact survival prognosis (<i>p</i> = 0.92) and were fully corrected by surgery in half of the cases.</p> Conclusion <p>Incorporating biological markers of inflammation, particularly CRP levels above 100&#xa0;mg/L, into pre-operative multidisciplinary discussions could improve patient selection for surgery. Hyperalgesic presentation should weigh against surgery, unlike incomplete neurological deficits. This study pointed new clinical and biological markers for short term post-operative survival. Further studies are needed to develop accurate prognosis models to help clinical decision-making.</p>

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Evaluation of early-death predictive factors and assessment of the benefits-risks ratio among patients with vertebral metastases needing surgery

  • 期刊论文

  • 发表日期：

    2025年4月22日

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  • Johanna Dautelle,
  • Anne-Laure Saint-Pol,
  • Aude Etienne l’Hospital,
  • Cécile Degryse,
  • Hugues de Courson,
  • Matthieu Biais

摘要

Introduction

Preoperative survival prognostication is the main factor to consider when selecting patients who will benefit from metastatic spine surgery. Since patients’ selection for surgery is not fully standardized, we aim to identify clinical, oncological and biological markers associated with poor post-operative prognosis.

Methods

A retrospective analysis was conducted in 105 patients referred to a specialized center for surgery of spinal metastasis between October 2020 and January 2022. Detailed clinical and biological variables were collected. Univariate and multivariate analyses were performed to assess overall survival.

Results

Among the 105 patients included, One-third died within six months. Multivariate survival analysis identified age, Karnofsky score, hyperalgesia and C-reactive protein (CRP) as independently associated with shorter survival. Patients with CRP values above 100 mg/L had a 57% mortality rate at three months. Hyperalgesic patients had a higher mortality rate at three months (p = 0.047), and preoperative use of strong opioids was significantly associated with lower rates of pain relief (p = 0.042). However, pre-operative neurological deficits did not significantly impact survival prognosis (p = 0.92) and were fully corrected by surgery in half of the cases.

Conclusion

Incorporating biological markers of inflammation, particularly CRP levels above 100 mg/L, into pre-operative multidisciplinary discussions could improve patient selection for surgery. Hyperalgesic presentation should weigh against surgery, unlike incomplete neurological deficits. This study pointed new clinical and biological markers for short term post-operative survival. Further studies are needed to develop accurate prognosis models to help clinical decision-making.