Treating Spinal Metastases (Surgery or No) Improves End-Stage QOL

A natural history study confirms that treating spinal metastases—whether operatively or non-operatively—positively improves patient health-related quality of life.

The study, “A Natural History of Patients Treated Operatively and Nonoperatively for Spinal Metastases Over 2 Years Following Treatment,” is published in the April 2022 issue of the journal Spine. It investigated survival and functional outcomes after surgical and nonsurgical treatment.

“Surgical treatment has been touted as a means to preserve functional independence, quality of life, and survival. Nearly all prior investigations have been limited by retrospective design and relatively short-periods of post-treatment surveillance,” the study authors wrote.

The findings are based on data from patients enrolled in a spinal metastases treatment study conducted between 2017 and 2019. All participants were 18 or older. The analysis adjusted for age, biologic sex, comorbidities, type of metastatic lesion, neurologic symptoms at presentation, number of metastases involving the vertebral body, vertebral body collapse, New England Spinal Metastasis Score at presentation, and treatment strategy.

Overall, 202 patients were included in the study, 23% of which had died by 3 months following treatment initiation. By the one-year mark, 51% had died, and 70% at the two-year follow-up.

The researchers found no significant difference in survival between patients treated operatively and nonoperatively (p = 0.16). There was also no significant difference in health-related quality of life between the groups past 3 months post the initiation of treatment. New England Spinal Metastasis Score at presentation was significantly associated with mortality.

“We found that patients treated operatively and nonoperatively for spinal metastases benefitted from treatment in terms of Health-Related Quality of Life. Two-year mortality for the cohort as a whole was 70%. When prognosticating survival, the New England Spinal Metastasis Score appears to be an effective utility, particularly among patients with scores of 0 or 1,” they wrote.

Study authors include Grace X. Xiong, M.D. of Brigham and Women’s Hospital, W.A. Miles, M.D., of San Antonio Military Medical Center, Joseph H. Schwab, M.D., M.S., of Massachusetts General Hospital, Andrew K. Simpson, M.D., M.B.A., of Brigham and Women’s Hospital, Lananh Nguyen, M.Ed., of Brigham and Women’s Hospital, Daniel G. Tobert, M.D., of Massachusetts General Hospital, Tracy A. Balboni, M.D., M.P.H., of Brigham and Women’s Hospital, and John H. Shin, M.D., Marco L. Ferrone, M.D., and Andrew J. Schoenfeld, M.D., M.Sc., all of Brigham and Women’s Hospital.