PMID- 34171829
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230619
IS  - 1547-5646 (Electronic)
IS  - 1547-5646 (Linking)
VI  - 35
IP  - 3
DP  - 2021 Jun 25
TI  - The effectiveness of systemic therapies after surgery for metastatic renal cell 
      carcinoma to the spine: a propensity analysis controlling for sarcopenia, 
      frailty, and nutrition.
PG  - 356-365
LID - 10.3171/2020.12.SPINE201896 [doi]
AB  - OBJECTIVE: The effectiveness of starting systemic therapies after surgery for 
      spinal metastases from renal cell carcinoma (RCC) has not been evaluated in 
      randomized controlled trials. Agents that target tyrosine kinases, mammalian 
      target of rapamycin signaling, and immune checkpoints are now commonly used. 
      Variables like sarcopenia, nutritional status, and frailty may impact recovery 
      from spine surgery and are considered when evaluating a patient's candidacy for 
      such treatments. A better understanding of the significance of these variables 
      may help improve patient selection for available treatment options after surgery. 
      The authors used comparative effectiveness methods to study the treatment effect 
      of postoperative systemic therapies (PSTs) on survival. METHODS: Univariable and 
      multivariable Cox regression analyses were performed to determine factors 
      associated with overall survival (OS) in a retrospective cohort of adult patients 
      who underwent spine surgery for metastatic RCC between 2010 and 2019. Propensity 
      score-matched (PSM) analysis and inverse probability weighting (IPW) were 
      performed to determine the treatment effect of PST on OS. To address confounding 
      and minimize bias in estimations, PSM and IPW were adjusted for covariates, 
      including age, sex, frailty, sarcopenia, nutrition, visceral metastases, 
      International Metastatic RCC Database Consortium (IMDC) risk score, and 
      performance status. RESULTS: In total, 88 patients (73.9% male; median age 62 
      years, range 29-84 years) were identified; 49 patients (55.7%) had an 
      intermediate IMDC risk, and 29 (33.0%) had a poor IMDC risk. The median follow-up 
      was 17 months (range 1-104 months) during which 57 patients (64.7%) died. Poor 
      IMDC risk (HR 3.2 [95% CI 1.08-9.3]), baseline performance status (Eastern 
      Cooperative Oncology Group score 3 or 4; HR 2.7 [95% CI 1.5-4.7]), and nutrition 
      (prognostic nutritional index [PNI] first tertile, PNI < 40.74; HR 2.69 [95% CI 
      1.42-5.1]) were associated with worse OS. Sarcopenia and frailty were not 
      significantly associated with poor survival. PST was associated with prolonged 
      OS, demonstrated by similar effects from multivariable Cox analysis (HR 0.55 [95% 
      CI 0.30-1.00]), PSM (HR 0.53 [95% CI 0.29-0.93]), IPW (HR 0.47 [95% CI 
      0.24-0.94]), and comparable confidence intervals. The median survival for those 
      receiving PST was 28 (95% CI 19-43) months versus 12 (95% CI 4-37) months for 
      those who only had surgery (log-rank p = 0.027). CONCLUSIONS: This comparative 
      analysis demonstrated that PST is associated with improved survival in specific 
      cohorts with metastatic spinal RCC after adjusting for frailty, sarcopenia, and 
      malnutrition. The marked differences in survival should be taken into 
      consideration when planning for surgery.
FAU - Massaad, Elie
AU  - Massaad E
AD  - Departments of1Neurosurgery.
FAU - Saylor, Philip J
AU  - Saylor PJ
AD  - 2Cancer Center, Massachusetts General Hospital; and.
FAU - Hadzipasic, Muhamed
AU  - Hadzipasic M
AD  - Departments of1Neurosurgery.
FAU - Kiapour, Ali
AU  - Kiapour A
AD  - Departments of1Neurosurgery.
FAU - Oh, Kevin
AU  - Oh K
AD  - 3Radiation Oncology, and.
FAU - Schwab, Joseph H
AU  - Schwab JH
AD  - 4Orthopedic Surgery, and.
FAU - Schoenfeld, Andrew J
AU  - Schoenfeld AJ
AD  - 5Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical 
      School, Boston, Massachusetts.
FAU - Shankar, Ganesh M
AU  - Shankar GM
AD  - Departments of1Neurosurgery.
FAU - Shin, John H
AU  - Shin JH
AD  - Departments of1Neurosurgery.
LA  - eng
PT  - Journal Article
DEP - 20210625
PL  - United States
TA  - J Neurosurg Spine
JT  - Journal of neurosurgery. Spine
JID - 101223545
SB  - IM
OTO - NOTNLM
OT  - frailty
OT  - oncology
OT  - renal cell carcinoma
OT  - sarcopenia
OT  - spine metastasis
OT  - spine surgery
OT  - survival
EDAT- 2021/06/26 06:00
MHDA- 2021/06/26 06:01
CRDT- 2021/06/25 20:31
PHST- 2020/10/23 00:00 [received]
PHST- 2020/12/09 00:00 [accepted]
PHST- 2021/06/26 06:01 [medline]
PHST- 2021/06/26 06:00 [pubmed]
PHST- 2021/06/25 20:31 [entrez]
AID - 2020.12.SPINE201896 [pii]
AID - 10.3171/2020.12.SPINE201896 [doi]
PST - epublish
SO  - J Neurosurg Spine. 2021 Jun 25;35(3):356-365. doi: 10.3171/2020.12.SPINE201896.