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Conditional survival after surgery for metastatic tumors of the spine: does prognosis change over time?

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Abstract

Purpose

Conditional survival (CS) provides a dynamic prediction of patient survival by incorporating the time an individual has already survived given their disease specific characteristics. The objective of the current study was to estimate CS among patients after surgery for spinal cord compression or spinal instability, as well as stratify CS according to relevant patient- and disease-related characteristics.

Methods

The clinical outcomes of 361 patients undergoing surgical management of metastatic spinal tumors were retrospectively analyzed. Stratification of this cohort according to disease and surgery-specific characteristics allowed for univariate and multivariate statistical analyses of our study population. Observed overall and conditional survival estimates were calculated by the Kaplan–Meier method.

Results

12-month conditional survival in patients undergoing surgical management of metastatic spine tumors increased from 57% at baseline to 70% at 24 months following spine surgery. Overall survival (OS) was influenced by CCI grade, Katagiri tumor type, presence of lung metastasis, type of spine surgery, presence of postoperative systemic therapy and ambulatory status at follow-up. Analyses of OS and CS by prognostic strata were similar with exception of stratification by surgery type. Differences in survival between strata tend to converge over time. Unfavorable factors for OS appear to be less relevant after a period of 24 months following spine surgery.

Conclusion

Patients after surgery for metastatic tumors of the spine can expect a positive trend in conditional survival as survivorship increases. Even patients with a more severe disease can be encouraged with gains in conditional survival over time.

Level of evidence

Level IV (retrospective cohort study).

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Availability of data and material

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

The R code generated during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Vreden National Medical Research Center of Traumatology and Orthopedics, Saint-Petersburg, Russia

    Nikita Zaborovskii, Dmitrii Ptashnikov, Dmitrii Mikaylov, Sergei Masevnin, Oleg Smekalenkov & Vladislav Murakhovsky

  2. Saint-Petersburg State University, Saint-Petersburg, Russia

    Nikita Zaborovskii

  3. North-Western State Medical University named after I.I.Mechnikov, Saint-Petersburg, Russia

    Dmitrii Ptashnikov

  4. San Francisco Orthopaedic Residency Program/ Saint Mary’s Medical Center, San Francisco, CA, USA

    Adam Schlauch, John Shapton & Dimitriy Kondrashov

  5. Traumatología Elgeadi/Hospital Quirónsalud Valle del Henares, Madrid, Spain

    Anton Denisov

  6. Traumatología Elgeadi/Hospital Quirónsalud San José, Madrid, Spain

    Anton Denisov

  7. Hospital 12 de Octubre Health Research Institute, Madrid, Spain

    Anton Denisov

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  1. Nikita Zaborovskii
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Correspondence to Dimitriy Kondrashov.

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The study was approved by the Hospital Institutional Review Board and complied with International Ethical Guidelines for Biomedical Research, Declaration of Helsinki, and local laws.

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Zaborovskii, N., Schlauch, A., Shapton, J. et al. Conditional survival after surgery for metastatic tumors of the spine: does prognosis change over time?. Eur Spine J 32, 1010–1020 (2023). https://doi.org/10.1007/s00586-023-07548-0

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  • DOI: https://doi.org/10.1007/s00586-023-07548-0

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