title: Prediction of Quality of Life and Survival After Surgery for Symptomatic Spinal Metastases: A Multicenter Cohort Study to Determine Suitability for Surgical Treatment.
abstract: BACKGROUND
  Surgery for symptomatic spinal metastases aims to improve quality of life, pain, function, and stability. Complications in the postoperative period are not uncommon; therefore, it is important to select appropriate patients who are likely to benefit the greatest from surgery. Previous studies have focused on predicting survival rather than quality of life after surgery.
  
  
  OBJECTIVE
  To determine preoperative patient characteristics that predict postoperative quality of life and survival in patients who undergo surgery for spinal metastases.
  
  
  METHODS
  In a prospective cohort study of 922 patients with spinal metastases who underwent surgery, we performed preoperative and postoperative assessment of EuroQol EQ-5D quality of life, visual analog score for pain, Karnofsky physical functioning score, complication rates, and survival.
  
  
  RESULTS
  The primary tumor type, number of spinal metastases, and presence of visceral metastases were independent predictors of survival. Predictors of quality of life after surgery included preoperative EQ-5D (P = .002), Frankel score (P < .001), and Karnofsky Performance Status (P < .001).
  
  
  CONCLUSIONS
  Data from the largest prospective surgical series of patients with symptomatic spinal metastases revealed that tumor type, the number of spinal metastases, and the presence of visceral metastases are the most useful predictors of survival and that quality of life is best predicted by preoperative Karnofsky, Frankel, and EQ-5D scores. The Karnofsky score predicts quality of life and survival and is easy to determine at the bedside, unlike the EQ-5D index. Karnofsky score, tumor type, and spinal and visceral metastases should be considered the 4 most important prognostic variables that influence patient management.
authors.affiliation: *Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, University College London, London, United Kingdom; ‡Departments of Neurosurgery and Orthopedic Surgery, Thomas Jefferson University and Hospitals, Philadelphia, Pennsylvania; §Department of Neurosurgery, Medical Center Haaglanden, Haaglanden, the Netherlands; ¶Department of Orthopedic Surgery, L'Institut Mutualiste Montsouris, Paris, France; ‖Department of Orthopedic Surgery, University Hospital of Aarhus, Aarhus, Denmark; #Departments of Orthopedic and Neurological Surgery, Washington University, St. Louis, Missouri; **Department of Neurosurgery, Groningen, the Netherlands; ‡‡Division of Neurosurgery, University Hospital Leuven, Leuven, Belgium; §§Division of Neurosurgery and Spinal Program, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada; ¶¶Department of Orthopedic Surgery, Kanazawa Medical University Hospital, Kanazawa, Japan; ‖‖Spinal Unit, Hospital Universitario Dr Peset, Valencia, Spain; ##Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands; ***Department of Neurosurgery, Leiden University Medical Centre, Leiden, the Netherlands; ‡‡‡Centre for Spine Studies and Surgery, Queens Medical Centre, Nottingham, United Kingdom; §§§Department of Orthopaedic Surgery, Nihon University School of Medicine, Japan; ¶¶¶Department of Orthopedic Surgery, Kanazawa University, Kanazawa, Japan; ‖‖‖Department of Neurosurgery, Jackson Memorial Hospital, University of Miami, Miami, Florida.
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mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D013125:Spinal Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D055815:Young Adult