bims-rebome 2025-09-07 papers

Front Oncol. 2025 ;15 1625545

Can we predict neurological complications in patients with metastatic spinal tumors?

Chul Jung, Hee Tae Shin, Cho Rong Bae, Joon Hee Lee, Jin Hoon Park, Jae-Hwan Cho, Choong Guen Chee, Jae Yong Jeon.

Background: Previous studies primarily analyzed spinal cord injuries in patients with metastatic spinal tumors after such injuries had already occurred. This study aimed to determine whether clinical and radiological factors are associated with the occurrence and severity of newly developed spinal cord injuries within 1 year in patients with metastatic spinal tumors.
Methods: We retrospectively examined patients with metastatic spinal tumors who were referred to the Department of Rehabilitation Medicine between 2017 and 2021. Using patients' clinical data and magnetic resonance imaging (MRI) findings, we investigated whether pain characteristics, Spinal Instability Neoplastic Score (SINS), and Epidural Spinal Cord Compression (ESCC) grades were associated with the occurrence and severity of spinal cord injuries within 1 year of MRI evaluation.
Results: Among the 70 included patients, 40 developed spinal cord injuries. Multivariate analysis identified an ESCC grade 2 or 3 (high-grade ESCC) as the only significant predictor of spinal cord injury within 1 year (P = 0.016). Higher ESCC grades were also significantly associated with a shorter time to onset of spinal cord injuries (P = 0.003). Regarding the severity of spinal cord injuries, the total score and categories of SINS were significantly higher in the mild deficit group than in the moderate to severe deficit group (P = 0.024 and P = 0.049, respectively).
Conclusions: In patients with metastatic spinal tumors, high-grade ESCC was a significant predictor of spinal cord injury within 1 year and was associated with an earlier onset of spinal cord injury. Radicular pain and unstable spines based on SINS categories were also strongly associated with the occurrence of spinal cord injury. This study provides valuable insights for predicting 1-year functional outcomes and determining management strategies for spinal metastases.

Keywords: epidural spinal cord compression scale; metastatic spinal tumor; neurological complication; radicular pain; spinal cord injury; spinal instability neoplastic score

DOI: https://doi.org/10.3389/fonc.2025.1625545

Spine J. 2025 Aug 27. pii: S1529-9430(25)00739-9. [Epub ahead of print]

Multicentre External Validation of the New England Spinal Metastasis Score (NESMS) in Operative and Non-Operative Patients with Metastatic Spinal Cord Compression.

William Giles, Lori Low, Anna L Watts, Vasudha Narayanaswamy, Osanmofe Gbenebichie, Alex Burnett, Doreen Koske, Caroline Wilson, Neil Chiverton, James Tomlinson, Shreya Srinivas.

BACKGROUND CONTEXT: Metastatic spinal cord compression (MSCC) presents complex treatment dilemmas where predicting survival is crucial for clinical decision-making.
PURPOSE: The New England Spinal Metastasis Score (NESMS) has shown promise, but external validation is needed to confirm its broader applicability.
STUDY DESIGN: Patients were assigned NESMS retrospectively based on ambulatory status, serum albumin level, and modified Bauer score.
PATIENT SAMPLE: This retrospective multicentre study included 322 adult patients with radiologically confirmed MSCC who presented for initial treatment over a 3-year period at two partner institutions.
OUTCOME MEASURES: The primary outcome was mortality at 12 months, with secondary outcomes of mortality at 3 and 6 months.
METHODS: Kaplan-Meier survival analysis and multivariate logistic regression were used to evaluate NESMS performance in predicting mortality and its discriminative capacity, while adjusting for potential confounders.
RESULTS: The cohort had a median age of 70 years, with 65% male patients. Overall 12-month mortality was 75%. NESMS demonstrated excellent discriminative capacity for predicting 12-month mortality (c-statistic 0.82, p<0.001) with clear stepwise differences in survival between NESMS levels (mortality: NESMS 0=98%, NESMS 1=88%, NESMS 2=75%, NESMS 3=46%). Multivariate analysis confirmed significantly greater odds of mortality with decreasing NESMS (NESMS 0: OR 35.92, CI 6.90-662.6; NESMS 1: OR 6.97, CI 3.22-16.02; NESMS 2: OR 2.69, CI 1.35-5.42; all p<0.05 compared to NESMS 3). Operative management was associated with significantly lower mortality (OR 0.28, CI 0.15-0.51; p<0.001).
CONCLUSIONS: This study externally validates the usefulness of the NESMS in predicting survival for both operative and non-operative patients with MSCC. Further, we observed clear stepwise increases in mortality with worsening NESMS.

Keywords: Metastatic spinal cord compression; Prognostic score; Spinal metastases; Survival prediction

DOI: https://doi.org/10.1016/j.spinee.2025.08.333

Spine (Phila Pa 1976). 2025 Sep 03.

Effect of Preoperative Nutritional Status on Postoperative Clinical Outcomes of Patients with Metastatic Spinal Tumors: Japan Association of Spine Surgeons with Ambition Multicenter Study.

JASA Study Group

STUDY DESIGN: A multicenter prospective study.
OBJECTIVE: To evaluate the effect of preoperative nutritional status, assessed using the Prognostic Nutritional Index (PNI), on clinical outcomes, including survival prognosis, postoperative complications, hospitalization duration, and functional prognosis, in patients with metastatic spinal tumors undergoing surgery.
SUMMARY OF BACKGROUND DATA: Malnutrition is common in patients with cancer and is associated with poor clinical outcomes. However, data on the role of nutritional status in metastatic spinal tumors are limited.
METHODS: We included 309 patients who underwent surgery for metastatic spinal tumors between October 2018 and March 2021. Patients were divided into two groups: normal nutrition (PNI ≥40) and malnutrition (PNI <40). Clinical outcomes, including 1-year mortality, postoperative complications, and functional improvements (performance status, Frankel grade, Barthel Index, Vitality Index, and EuroQol 5-Dimension 5-level), were compared using propensity score matching to adjust for confounding factors, such as age, sex, preoperative chemotherapy, performance status, primary tumor type, and visceral metastases.
RESULTS: Thirty-six percent of patients were malnourished. After propensity score matching, the malnutrition group had a significantly higher mortality rate within 1 year than the normal nutrition group (55% vs. 31%, P<0.001) and showed limited physical improvement, including neurological recovery, 1 month postoperatively. However, improvements in motivation and quality of life (QOL) were comparable between the groups, and physical function recovery at 6 months was similar. No significant differences in postoperative complications or length of hospital stay were observed between the groups.
CONCLUSION: Preoperative malnutrition was observed in 36% of patients with metastatic spinal tumors who underwent surgery and was associated with a poor postoperative survival prognosis and delayed physical recovery. However, surgical treatment improved motivation, QOL, and physical function 6 months after surgery. These findings highlight the importance of assessing the nutritional status preoperatively and considering both survival and functional prognoses when selecting surgical treatment for patients with malnutrition.

Keywords: Barthel Index; Metastatic spinal tumors; Prognostic Nutritional Index (PNI); malnutrition; neurological outcome; performance status; postoperative complications; propensity score matching; quality of life; surgical treatment; survival prognosis

DOI: https://doi.org/10.1097/BRS.0000000000005487

Spine (Phila Pa 1976). 2025 Sep 04.

Cost-effectiveness of Surgery for Spinal Metastasis: A Systematic Review.

Philip Heesen, Emil O R Nordin, Vivek Sanker, María José Cavagnaro, Corinna C Zygourakis, John Ratliff, Atman M Desai.

STUDY DESIGN: Systematic review.
OBJECTIVE: The purpose of this study was to assess the cost-effectiveness of surgery for spinal metastasis therapy.
SUMMARY OF BACKGROUND DATA: The optimal treatment for many cases of spinal metastasis (SM) is surgery followed by adjuvant radiotherapy (RT). However, the cost-effectiveness of combined therapy (CT; surgery & RT) is unclear due to the short median survival time among SM patients and the higher costs of combined therapy compared to RT alone.
METHODS: We performed a systematic literature search from inception to 01/21/2024. We included studies that reported on the cost-effectiveness of surgical intervention for SM and assessed their quality using Quality of Health Economic Studies instrument.
RESULTS: We identified 5,024 studies of which 8 met our inclusion. All included studies were of fair to high quality. Of 7 studies that compared CT to definitive RT, six concluded that CT was cost-effective. Of note, one of the studies concluding that CT was cost-effective, only found CT to be cost effectiveness when considering patients with a 3-month survival probability above 50%. An additional study compared their calculated Incremental Cost Effectiveness Ratio (ICER) value to the standard Willingness to Pay (WTP) threshold in Thailand and concluded that CT was not cost-effective in Thailand. After comparing their reported ICER value to a commonly used WTP in the United States, we found CT to be cost-effective.
CONCLUSIONS: We found CT consisting of surgery and RT to be cost effective in 6 out of 7 (85.7%) studies. Cost effectiveness might be even more pronounced in certain patient subgroups, such as patients with a high predicted survival. However, most studies did not report therapy details - a factor which could greatly influence cost-effectiveness.

Keywords: cost-effectiveness; radiotherapy; spinal metastasis; surgery

DOI: https://doi.org/10.1097/BRS.0000000000005486