Influence of preoperative biological parameters on postoperative complications and survival in spinal bone metastasis. A multicenter prospective study

Solène Prost (1, 2) , Charlie Bouthors (3) , Stéphane Fuentes (1, 2) , Yann-Philippe Charles (4) , Charles Court (3) , Christian Mazel , Benjamin Blondel (1, 2) , Paul Bonnevialle (5) , Frédéric Sailhan (6)

1 ISM - Institut des Sciences du Mouvement Etienne Jules Marey
2 TIMONE - Hôpital de la Timone [CHU - APHM]
3 Hôpital Bicêtre [AP-HP, Le Kremlin-Bicêtre]
4 HUS - Les Hôpitaux Universitaires de Strasbourg
5 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
6 Hôpital Cochin [AP-HP]

Introduction: Onset of spinal bone metastasis is a turning point in the progression of tumoral disease; although incidence is increasing, management is not standardized. Various prognostic scores are available, but advances in medical and surgical treatment have made them less well adapted, and sometimes discordant for a given patient. It would therefore be useful to develop new prognostic instruments. The aim of the present study was to identify biologic risk factors for onset of postoperative complications and death following spinal bone metastasis surgery. Material and methods: A prospective multicenter study included all patients operated on for spinal bone metastasis between November 2015 and May 2017. The main epidemiologic data and biologic data (CRP, albuminemia, calcemia) were collected preoperatively. Surgical strategy, death and/or postoperative complications were collected prospectively. Results: Five of the initial 264 patients died during the immediate postoperative course, and 107 within 6 months. At 1 year, 57 patients remained alive. Twenty-six (10%) were lost to follow-up. Preoperative albuminemia < 35 g/L (29% of patients), calcemia > 2.6 nmol/L (8%) and CRP > 10 mg/L (47.5%) were associated with significantly elevated mortality. Only CRP elevation correlated with postoperative complications rate. Conclusion: The study confirmed the prognostic value of 3 biologic parameters (CRP level, albuminemia, calcemia) for survival after spinal bone metastasis surgery. A hybrid score taking account of not only clinical but also biologic parameters should be developed to improve estimation of survival.

Mots clés: Spinal bone metastasis; Survival; Postoperative complications; Biologic parameters

Domaines: Cancer; Rhumatologie et système ostéo-articulaire; Chirurgie

Solène Prost, Charlie Bouthors, Stéphane Fuentes, Yann-Philippe Charles, Charles Court, et al.. Influence of preoperative biological parameters on postoperative complications and survival in spinal bone metastasis. A multicenter prospective study. Orthopaedics & Traumatology: Surgery & Research, 2020, 106 (6), pp.1033-1038. ⟨10.1016/j.otsr.2019.11.031⟩. ⟨hal-03187015⟩