Evaluation of prognostic preoperative factors in patients undergoing surgery for spinal metastases: Results in a consecutive series of 81 cases

Background: Surgical treatment of spinal metastases should be tailored to provide pain control, neurological deficitimprovement, and vertebral stability with low operative morbidity and mortality. The aim of this study was to analyzethe predictive value of some preoperative factors on overall survival in patients undergoing surgery for spinal metastases.Methods: We retrospectively analyzed a consecutive series of 81 patients who underwent surgery for spinal metastasesfrom 2015 and 2021 in the Clinic of Neurosurgery of Ancona (Italy). Data regarding patients’ baseline characteristics,preoperative Karnofsky Performance Status Score (KPS), and Frankel classification grading system, histology ofprimary tumor, Tokuhashi revised and Tomita scores, Spine Instability Neoplastic Score, and Epidural Spinal CordCompression Classification were collected. We also evaluated the interval time between the diagnosis of the primarytumor and the onset of spinal metastasis, the type of surgery, the administration of adjuvant therapy, postoperativepain and Frankel grade, and complications after surgery. The relationship between patients’ overall survival andpredictive preoperative factors was analyzed by the Kaplan–Meier method. For the univariate and multivariateanalysis, the log-rank test and Cox regression model were used. P ≤ 0.05 was considered as statistically significant.Results: After surgery, the median survival time was 13 months. In our series, the histology of the primarytumor (P < 0.001), the Tomita (P < 0.001) and the Tokuhashi revised scores (P < 0.001), the preoperative KPS(P < 0.001), the adjuvant therapy (P < 0.001), the postoperative Frankel grade (P < 0.001), and the postoperativepain improvement (P < 0.001) were significantly related to overall survival in the univariate analysis. In themultivariate analysis, the Tomita (P < 0.001), Tokuhashi revised scores (P < 0.001), and the adjuvant therapy wereconfirmed as independent prognostic factors.Conclusion: These data suggest that patients with limited extension of primitive tumor and responsive to theadjuvant therapy are the best candidates for surgery with better outcome.