Sarcopenia Predicts Overall Survival in Patients with Lung, Breast, Prostate, or Myeloma Spine Metastases Undergoing Stereotactic Body Radiation Therapy (SBRT), Independent of Histology

Hesham Mostafa Zakaria, Jeremy T. Llaniguez, Edvin Telemi, Matthew Chuang, Mohamed Abouelleil, Brandon Wilkinson, Ankush Chandra, David Boyce-Fappiano, Erinma Elibe, Lonni Schultz, Farzan Siddiqui, Brent Griffith, Steven N. Kalkanis, Ian Yu Lee, Victor Chang

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)705-716
Number of pages12
JournalNeurosurgery
Volume86
Issue number5
DOIs
StatePublished - May 1 2020
Externally publishedYes

Keywords

  • Frailty
  • Medical oncology
  • Metastasis
  • Sarcopenia
  • Spine

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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