SADA-12 MALNUTRITION AS THE CANARY IN THE COAL MINE: NUTRITIONAL STATUS AND ITS ASSOCIATION WITH SURVIVAL IN PATIENTS WITH METASTATIC SPINE DISEASE
Eli Johnson, Anne L Versteeg, Raphaële Charest-Morin, Rafael de la Garza Ramos, Ilya Laufer, William G J Teixeira, Ori Barzilai, Alessandro Gassbarrini, Michael Fehlings, Dean Chou, Ziya L Gokaslan, Cordula Netzer, Alessandro Luzzati, Jorrit-Jan Verlaan, Tony Goldshlager, John Shin, John E O’Toole, Daniel M Sciubba, Chetan Bettegowda, Michelle J Clarke, Michael H Weber, Addisu Mesfin, Norio Kawahara, Shalin S Patel, Alexander C Disch, Jeremy Reynolds, Aron Lazary, Stefano Boriani, Nicholas Dea, Arjun Sahgal, Laurence Rhines, Charles G Fisher, , C Rory GoodwinAbstract
Introduction
Patients with metastatic spine disease (MSD) present with varying degrees of systemic illness and frailty. Given the palliative intent of surgery and radiation treatment for MSD, treatment risks must be judiciously weighed against potential benefits. We sought to examine the impact of peroperative nutritional status as measured by the PG-SGA on survival in patients undergoing surgery and radiation for MSD.
Methods
This study involved an international, multicenter prospective, observational registry of patients with MSD: AO Knowledge Forum Tumor’s Metastatic Tumor Research and Outcomes Network (MTRON). Variables including baseline demographics, oncologic data, adverse events (medical adverse events and surgical complications), length of stay, and nutritional status were prospectively collected. The Patient-Generated Subjective Global Assessment (PG-SGA) was used to evaluate nutritional status.
Results
A total of 589 patients were included in this study; 469 (80%) of whom underwent surgery and radiation and 120 (20%) of whom underwent radiation alone. The majority of patients (362, 61%) were classified as well nourished, however, 68 patients (12%) were classified as severely malnourished. Among patients that underwent surgery and radiation, the median overall survival of well nourished patients was 491 days compared to 117 days in the severely malnourished patients (p < 0.001). A multivariate analysis demonstrated severe malnourishment and ECOG performance status of 3 or 4 were associated with worse overall survival.
Conclusion
Malnutrition as measured by the PG-SGA demonstrated to be significantly and independently associated with perioperative survival in patients with MSD. Further studies that investigate optimal pre-treatment optimization for patients with MSD in order to mitigate morbidity and mortality risk are essential.