Background

Surgical treatment of spinal metastases has been associated with high morbidity and mortality in patients with sarcopenia based on low skeletal muscle mass. We assessed physical performance using the Eastern Cooperative Oncology Group performance status scale and the Barthel Index on the 30th day after palliative surgery for spinal metastases and investigated the effectiveness of surgery according to sarcopenia assessed by skeletal muscle mass.

Methods

We retrospectively analyzed 78 consecutive patients with thoracic and lumbar spinal metastases who underwent palliative surgery. The value of the area of the psoas major muscle at the L3 level normalized by the vertebral area was divided into first, middle, and third tertiles. Clinical variables were compared by tertile. Variables affecting the 30-day good performance status were investigated with univariate and multivariate analyses.

Results

The 30-day morbidity rates were 50%, 38.5%, and 15.4% by tertile. The 30-day mortality rate was 2%; all were in the first tertile. Good preoperative performance status scores were seen in 15.4% of first and 50% of third tertile patients. Postoperatively, the performance status improved in all groups, with 30.8%, 65.4%, and 92.3% by tertile. Multivariate regression analysis revealed that a good preoperative performance status (OR: 15.50, 95% CI: 1.610–149.00, P < 0.05) and the value of the area of the psoas major muscle at the L3 level normalized by the vertebral area not in the first tertile (OR: 0.22, 95% CI: 0.06–0.82, P < 0.05) were significant predictors of a good postoperative 30-day performance status.

Conclusions

A good preoperative performance status and exclusion from the first tertile were clinical factors predicting a good postoperative 30-day performance status. In patients with large psoas muscle mass (third tertile), a good 30-day performance status can be expected after surgery, suggesting that surgery in this population should be pursued aggressively.

中文翻译：

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术前骨骼肌质量作为脊柱转移姑息手术后身体机能恢复预测指标的临床研究

背景

脊柱转移瘤的手术治疗与低骨骼肌质量的肌肉减少症患者的高发病率和死亡率相关。我们使用东部肿瘤合作组体力状态量表和脊柱转移姑息手术后第 30 天的 Barthel 指数评估身体表现，并根据骨骼肌质量评估的肌少症调查手术的有效性。

方法

我们回顾性分析了连续 78 例接受姑息手术的胸腰椎转移患者。由椎体面积归一化的 L3 水平腰大肌面积值分为第一、中间和第三三分位数。临床变量按三分位数进行比较。通过单变量和多变量分析研究了影响 30 天良好表现状态的变量。

结果

按三分位数计算，30 天发病率分别为 50%、38.5% 和 15.4%。30天死亡率为2%；全部都在第一个三分位数。第一三分位患者中 15.4% 和第三三分位患者中 50% 的患者术前表现状态良好。术后，所有组的体能状态均有所改善，按三分位数计算分别为 30.8%、65.4% 和 92.3%。多变量回归分析显示，良好的术前体能状态（OR：15.50，95% CI：1.610-149.00，P < 0.05）以及L3水平腰大肌面积的值由不在L3水平的椎体区域归一化。第一个三分位数（OR：0.22，95% CI：0.06-0.82，P < 0.05）是术后 30 天良好表现状态的重要预测因素。

结论

良好的术前体能状态和排除在第一个三分位数之外是预测良好的术后 30 天体能状态的临床因素。对于腰肌质量较大（第三个三分位）的患者，术后 30 天的体能状态预计良好，这表明该人群应积极进行手术。