1
|
Yamada K, Yoshii T, Toba M, Egawa S, Morishita S, Matsukura Y, Hirai T, Kudo A, Fushimi K. Trends in the surgical treatment for metastatic spinal tumor in Japanese administrative data between 2012 and 2020. Int J Clin Oncol 2024:10.1007/s10147-024-02537-9. [PMID: 38829471 DOI: 10.1007/s10147-024-02537-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/14/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Both cancer diagnosis/treatment modality and surgical technique for the spine have been developed recently. Nationwide trends in the surgical treatment for metastatic spinal tumors have not been reported in the last decades. This study aimed to examine recent trends in the surgical treatment for spinal metastasis and in-hospital patient outcomes using nationwide administrative hospital discharge data. METHODS The Diagnosis Procedure Combination database from 2012 to 2020 was used to extract data from patients who underwent surgical procedures for spinal metastasis with the number of non-metastatic spinal surgery at the institutions that have performed metastatic spine surgeries at least one case in the same year. Trends in the surgical treatment for spinal metastasis, patients' demographics, and in-hospital mortality/outcomes were investigated. RESULTS This study analyzed 10,321 eligible patients with spinal metastasis. The surgical treatment for spinal metastasis increased 1.68 times from 2012 to 2020, especially in fusion surgery, whereas the proportion of metastatic spinal surgery retained with a slight increase in the 2%s. Distributions of the primary site did not change, whereas age was getting older. In-hospital mortality and length of stay decreased over time (9.9-6.8%, p < 0.001; 37-30 days, p < 0.001). Postoperative complication and unfavorable ambulatory retained stable and slightly decreased, respectively. CONCLUSION During the last decade, surgical treatment for spinal metastasis, especially fusion surgery, has increased in Japan. In-hospital mortality and length of stay decreased. Recent advances in cancer treatment and surgical techniques might influence this trend.
Collapse
Affiliation(s)
- Kentaro Yamada
- Department of Orthopaedics and Trauma Research, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedics, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | - Mikayo Toba
- Department of Quality Management Center, Tokyo Medical and Dental Univ Hospital, Tokyo, Japan
| | - Satoru Egawa
- Department of Orthopaedics, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Shingo Morishita
- Department of Orthopaedics, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Yu Matsukura
- Department of Orthopaedics, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Takashi Hirai
- Department of Orthopaedics, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Atsushi Kudo
- Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics Section, Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|
2
|
Chavalparit P, Wilartratsami S, Santipas B, Ittichaiwong P, Veerakanjana K, Luksanapruksa P. Development of Machine-Learning Models to Predict Ambulation Outcomes Following Spinal Metastasis Surgery. Asian Spine J 2023; 17:1013-1023. [PMID: 38050361 PMCID: PMC10764138 DOI: 10.31616/asj.2023.0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/30/2023] [Accepted: 07/10/2023] [Indexed: 12/06/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. PURPOSE This study aimed to develop machine-learning algorithms to predict ambulation outcomes following surgery for spinal metastasis. OVERVIEW OF LITERATURE Postoperative ambulation status following spinal metastasis surgery is currently difficult to predict. The improved ability to predict this important postoperative outcome would facilitate management decision-making and help in determining realistic treatment goals. METHODS This retrospective study included patients who underwent spinal metastasis at a university-based medical center in Thailand between January 2009 and November 2021. Collected data included preoperative parameters and ambulatory status 90 and 180 days following surgery. Thirteen machine-learning algorithms, namely, artificial neural network, logistic regression, CatBoost classifier, linear discriminant analysis, extreme gradient boosting, extra trees classifier, random forest classifier, gradient boosting classifier, light gradient boosting machine, naïve Bayes, K-neighbor classifier, Ada boost classifier, and decision tree classifier were developed to predict ambulatory status 90 and 180 days following surgery. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC) and F1-score. RESULTS In total, 167 patients were enrolled. The number of patients classified as ambulatory 90 and 180 days following surgery was 140 (81.9%) and 137 (82.0%), respectively. The extreme gradient boosting algorithm was found to most accurately predict 180-day ambulatory outcome (AUC, 0.85; F1-score, 0.90), and the decision tree algorithm most accurately predicted 90-day ambulatory outcome (AUC, 0.94; F1-score, 0.88). CONCLUSIONS Machine-learning algorithms were effective in predicting ambulatory status following surgery for spinal metastasis. Based on our data, the extreme gradient boosting and decision tree best predicted postoperative ambulatory status 180 and 90 days after spinal metastasis surgery, respectively.
Collapse
Affiliation(s)
- Piya Chavalparit
- Department of Orthopaedic Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok,
Thailand
| | - Sirichai Wilartratsami
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok,
Thailand
| | - Borriwat Santipas
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok,
Thailand
| | - Piyalitt Ittichaiwong
- Siriraj Informatics and Data Innovation Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok,
Thailand
| | - Kanyakorn Veerakanjana
- Siriraj Informatics and Data Innovation Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok,
Thailand
| | - Panya Luksanapruksa
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok,
Thailand
| |
Collapse
|
3
|
Suvithayasiri S, Kim YJ, Liu Y, Trathitephun W, Asawasaksaku A, Quillo-Olvera J, Kotheeranurak V, Chagas H, Valencia CC, Serra MV, Isseldyk FV, Lee LH, Chen CM, Lokhande P, Park SM, Jitpakdee K, Patel KK, Kim JH, Mahatthanatrakul A, Luksanapruksa P, Wilartratsami S, Kim JS. The Role and Clinical Outcomes of Endoscopic Spine Surgery of Treating Spinal Metastases; Outcomes of 29 Cases From 8 Countries. Neurospine 2023; 20:608-619. [PMID: 37401080 PMCID: PMC10323327 DOI: 10.14245/ns.2346274.137] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/08/2023] [Accepted: 04/17/2023] [Indexed: 07/05/2023] Open
Abstract
OBJECTIVE We aim to report the outcomes and feasibility of endoscopic spine surgery used to treat symptomatic spinal metastases patients. This is the most extensive series of spinal metastases patients who underwent endoscopic spine surgery. METHODS A worldwide collaborative network group of endoscopic spine surgeons, named 'ESSSORG,' was established. Patients diagnosed with spinal metastases who underwent endoscopic spine surgery from 2012 to 2022 were retrospectively reviewed. All related patient data and clinical outcomes were gathered and analyzed before the surgery and the followtime period of 2 weeks, 1 month, 3 months, and 6 months. RESULTS A total of 29 patients from South Korea, Thailand, Taiwan, Mexico, Brazil, Argentina, Chile, and India, were included. The mean age was 59.59 years, and 11 of them were female. The total number of decompressed levels was 40. The technique was relatively equal (15 uniportal; 14 biportal). The average length of admission was 4.41 days. Of all patients with an American Spinal Injury Association Impairment Scale of D or lower before surgery, 62.06% reported having at least one recovery grade after the surgery. Almost all clinical outcomes parameters statistically significantly improved and maintained from 2 weeks to 6 months after the surgery. Few surgical-related complications (4 cases) were reported. CONCLUSION Endoscopic spine surgery is a valid option for treating spinal metastases patients as it could yield comparable results to other minimally invasive spine surgery techniques. As the aim is to improve the quality of life, this procedure is valuable and holds value in palliative oncologic spine surgery.
Collapse
Affiliation(s)
- Siravich Suvithayasiri
- Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Orthopedics, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Young-Jin Kim
- Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yanting Liu
- Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Warayos Trathitephun
- Department of Orthopedics, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | | | - Javier Quillo-Olvera
- The Brain and Spine Care, Minimally Invasive Spine Surgery Group, Hospital H+, Queretaro City, Mexico
| | - Vit Kotheeranurak
- Department of Orthopaedics, Faculty of Medicine Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand
| | - Haroldo Chagas
- Department of Neurosurgery, Hospital Federal da Lagoa, Rio de Janeiro, Brazil
| | | | | | | | - Lung-Hsing Lee
- Department of Orthopedics, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
| | - Chien-Min Chen
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Pramod Lokhande
- Department of Orthopaedics, Smt. Kashibai Navale Medical College and General Hospital, Pune, India
| | - Sang-Min Park
- Spine Center, Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul ational University Bundang Hospital, Seongnam, Korea
| | - Khanathip Jitpakdee
- Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Orthopedics, Queen Savang Vadhana Memorial Hospital, Chonburi, Thailand
| | - Kandarpkumar K. Patel
- Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung-Hoon Kim
- Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | - Panya Luksanapruksa
- Division of Spine Surgery, Department of Orthopaedics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sirichai Wilartratsami
- Division of Spine Surgery, Department of Orthopaedics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jin-Sung Kim
- Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
4
|
Suzuki A, Terai H, Takahashi S, Kato M, Toyoda H, Tamai K, Hori Y, Okamura Y, Nakamura H. Risk Factors for Poor Outcome after Palliative Surgery for Metastatic Spinal Tumors. J Clin Med 2023; 12:jcm12103442. [PMID: 37240548 DOI: 10.3390/jcm12103442] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/06/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Palliative surgery is performed to improve the quality of life of patients with spinal metastases. However, it is sometimes difficult to achieve the expected results because the patient's condition, and risk factors related to poor outcomes have not been well elucidated. This study aimed to evaluate the functional outcomes and investigate the risk factors for poor outcomes after palliative surgery for spinal metastasis. We retrospectively reviewed the records of 117 consecutive patients who underwent palliative surgery for spinal metastases. Neurological and ambulatory statuses were evaluated pre- and post-operatively. Poor outcomes were defined as no improvement or deterioration in functional status or early mortality, and the related risk factors were analyzed using multivariate logistic regression analysis. The results showed neurological improvement in 48% and ambulatory improvement in 70% of the patients with preoperative impairment, whereas 18% of the patients showed poor outcomes. In the multivariate analysis, low hemoglobin levels and low revised Tokuhashi scores were identified as risk factors for poor outcomes. The present results suggest that anemia and low revised Tokuhashi scores are related not only to life expectancy but also to functional recovery after surgery. Treatment options should be carefully selected for the patients with these factors.
Collapse
Affiliation(s)
- Akinobu Suzuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka 545-8585, Japan
| | - Hidetomi Terai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka 545-8585, Japan
| | - Shinji Takahashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka 545-8585, Japan
| | - Minori Kato
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka 545-8585, Japan
| | - Hiromitsu Toyoda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka 545-8585, Japan
| | - Koji Tamai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka 545-8585, Japan
| | - Yusuke Hori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka 545-8585, Japan
| | - Yuki Okamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka 545-8585, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka 545-8585, Japan
| |
Collapse
|