TY - JOUR
T1 - Sarcopenia Predicts Overall Survival in Patients with Lung, Breast, Prostate, or Myeloma Spine Metastases Undergoing Stereotactic Body Radiation Therapy (SBRT), Independent of Histology
AU - Zakaria, Hesham Mostafa
AU - Llaniguez, Jeremy T.
AU - Telemi, Edvin
AU - Chuang, Matthew
AU - Abouelleil, Mohamed
AU - Wilkinson, Brandon
AU - Chandra, Ankush
AU - Boyce-Fappiano, David
AU - Elibe, Erinma
AU - Schultz, Lonni
AU - Siddiqui, Farzan
AU - Griffith, Brent
AU - Kalkanis, Steven N.
AU - Lee, Ian Yu
AU - Chang, Victor
N1 - Publisher Copyright:
Copyright © 2019 by the Congress of Neurological Surgeons.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/5/1
Y1 - 2020/5/1
N2 - BACKGROUND: Predicting survival of patients with spinal metastases would help stratify treatments from aggressive to palliation. OBJECTIVE: To evaluate whether sarcopenia predicts survival in patients with lung, breast, prostate, or multiple myeloma spinal metastases. METHODS: Psoas muscle measurements in patients with spinal metastasis were taken from computed tomography scans at 2 time points: at first episode of stereotactic body radiation therapy (SBRT) and from the most recent scan available. Overall survival and hazard ratios were calculated with multivariate cox proportional hazards regression analyses. RESULTS: In 417 patients with spinal metastases, 40% had lung cancer, 27% breast, 21% prostate, and 11% myeloma. Overall survival was not associated with age, sex, ethnicity, levels treated, or SBRT volume. Multivariate analysis showed patients in the lowest psoas tertile had shorter survival (222 d, 95% CI = 185-323 d) as compared to the largest tertile (579 d, 95% CI = 405-815 d), (HR1.54, P =. 005). Median psoas size as a cutoff value was also strongly predictive for survival (HR1.48, P =. 002). Survival was independent of tumor histology. The psoas/vertebral body ratio was also successful in predicting overall survival independent of tumor histology and gender (HR1.52, P <. 01). Kaplan-Meier survival curves visually represent survival (P =. 0005). CONCLUSION: In patients with spine metastases, psoas muscle size as a hallmark of frailty/sarcopenia is an objective, simple, and effective way to identify patients who are at risk for shorter survival, regardless of tumor histology. This information can be used to help with surgical decision making in patients with advanced cancer, as patients with small psoas sizes are at higher risk of death.
AB - BACKGROUND: Predicting survival of patients with spinal metastases would help stratify treatments from aggressive to palliation. OBJECTIVE: To evaluate whether sarcopenia predicts survival in patients with lung, breast, prostate, or multiple myeloma spinal metastases. METHODS: Psoas muscle measurements in patients with spinal metastasis were taken from computed tomography scans at 2 time points: at first episode of stereotactic body radiation therapy (SBRT) and from the most recent scan available. Overall survival and hazard ratios were calculated with multivariate cox proportional hazards regression analyses. RESULTS: In 417 patients with spinal metastases, 40% had lung cancer, 27% breast, 21% prostate, and 11% myeloma. Overall survival was not associated with age, sex, ethnicity, levels treated, or SBRT volume. Multivariate analysis showed patients in the lowest psoas tertile had shorter survival (222 d, 95% CI = 185-323 d) as compared to the largest tertile (579 d, 95% CI = 405-815 d), (HR1.54, P =. 005). Median psoas size as a cutoff value was also strongly predictive for survival (HR1.48, P =. 002). Survival was independent of tumor histology. The psoas/vertebral body ratio was also successful in predicting overall survival independent of tumor histology and gender (HR1.52, P <. 01). Kaplan-Meier survival curves visually represent survival (P =. 0005). CONCLUSION: In patients with spine metastases, psoas muscle size as a hallmark of frailty/sarcopenia is an objective, simple, and effective way to identify patients who are at risk for shorter survival, regardless of tumor histology. This information can be used to help with surgical decision making in patients with advanced cancer, as patients with small psoas sizes are at higher risk of death.
KW - Frailty
KW - Medical oncology
KW - Metastasis
KW - Sarcopenia
KW - Spine
UR - http://www.scopus.com/inward/record.url?scp=85083544423&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85083544423&partnerID=8YFLogxK
U2 - 10.1093/neuros/nyz216
DO - 10.1093/neuros/nyz216
M3 - Article
C2 - 31232439
AN - SCOPUS:85083544423
VL - 86
SP - 705
EP - 716
JO - Neurosurgery
JF - Neurosurgery
SN - 0148-396X
IS - 5
ER -