Outcome Analysis in Metastatic Spinal Tumor Surgery Using Minimal Clinically Important Difference
Ryosuke Hirota, Tsutomu Oshigiri, Noriyuki Iesato, Makoto Emori, Atsushi Teramoto, Yuki Shiratani, Akinobu Suzuki, Koji Tamai, Takaki Shimizu, Takashi Yurube, Yutaro Kanda, Hiroyuki Tominaga, Ichiro Kawamura, Masayuki Ishihara, Masaaki Paku, Yohei Takahashi, Toru Funayama, Kousei Miura, Eiki Shirasawa, Hirokazu Inoue, Atsushi Kimura, Takuya Iimura, Hiroshi Moridaira, Hideaki Nakajima, Shuji Watanabe, Koji Akeda, Norihiko Takegami, Kazuo Nakanishi, Hirokatsu Sawada, Koji Matsumoto, Masahiro Funaba, Hidenori Suzuki, Haruki Funao, Takashi Hirai, Bungo Otsuki, Kazu Kobayakawa, Koji Uotani, Hiroaki Manabe, Shinji Tanishima, Ko Hashimoto, Chizuo Iwai, Daisuke Yamabe, Akihiko Hiyama, Shoji Seki, Yuta Goto, Masashi Miyazaki, Kazuyuki Watanabe, Toshio Nakamae, Takashi Kaito, Hiroaki Nakashima, Narihito Nagoshi, Satoshi Kato, Shiro Imagama, Kota Watanabe, Gen Inoue, Takeo FuruyaStudy Design:
Multicenter prospective registry study.
Objective:
To classify patients according to whether they achieved the minimum clinically important difference (MCID) in health-related quality of life (HRQoL) after surgery for metastatic spinal tumors and to identify preoperative factors associated with clinically meaningful improvement.
Summary of Background Data:
As survival in patients with metastatic spinal tumors continues to improve, evaluating clinically meaningful changes in HRQoL has become increasingly important. However, factors associated with achieving clinically meaningful postoperative improvement remain unclear.
Methods:
Between 2018 and 2021, 413 patients undergoing surgery for metastatic spinal tumors were prospectively enrolled from 35 centers in Japan. Patients with available preoperative and 6-month postoperative EQ-5D-5L data were included in the MCID analysis (n=171). Patients were classified into the MCID improvement and non-MCID improvement groups according to the previously established MCID threshold for the EQ-5D-5L index. Patient-reported outcomes (PROs), clinical characteristics, and functional measures were compared between groups, and multivariable logistic regression analysis was performed to identify preoperative factors associated with clinically meaningful improvement.
Results:
Patients in the MCID improvement group demonstrated significantly greater improvements in the EQ-5D-5L index, EQ-VAS, and other PRO measures than those in the non-MCID improvement group. Compared with the non-MCID improvement group, they had poorer baseline HRQoL, poorer functional status, greater pain, and lower independence in activities of daily living. Exploratory multivariable analysis identified lower independence in dressing and greater impairment in the mobility, pain/discomfort, and anxiety/depression domains as candidate factors associated with clinically meaningful improvement.
Conclusion:
Patients with poorer baseline HRQoL and functional status were more likely to achieve clinically meaningful improvement after surgery for metastatic spinal tumors. These findings suggest that baseline HRQoL should be considered when interpreting postoperative outcomes and counseling patients regarding the expected benefits of surgical treatment.