Introduction

 Palliative surgery for spinal metastasis plays an important role in improving and maintaining the activity of daily living (ADL) and quality of life (QOL). With recent progress in cancer treatment and aging society, the elderly patients with spinal metastasis have been increasing rapidly. However, it is still unclear whether the surgery for elderly patients is effective as well as younger patients.

Aim

 The purpose of this study was to elucidate surgical outcomes for spinal metastasis in elderly patients, especially with a focus on ADL and QOL.

Material and Methods

 We prospectively analyzed 101 patients with spinal metastases who underwent palliative surgery from 2013 to 2016 due to progressive neurological deficits or intractable pain. These patients were divided into the two groups (<70 years and ≥70 years). Eastern Cooperative Oncology Group Performance Status (PS), Barthel index (BI), and EuroQol-5 dimension (EQ-5D) were assessed at study enrollment (baseline), one, three, and six months postoperatively. Improvement or deterioration of each subjective health state value was defined as a ≥ one-level change in the PS, a ≥ ten-point change in the BI, and a ≥ 10% change in the EQ-5D score. The survival times and complications were also collected. Unpaired t test and the Fischer exact test were used to identify the difference of perioperative factors between the two groups. The chronological changes between the two groups were identified by Kruskal-Wallis test and Scheffe post hoc test. All statistical analyses were performed with significance set at a P value <0.05.

Results

 There were 65 patients aged <70 years (mean, 59.6; range, 32–69) and 36 patients aged ≥70 years (75.9, 70–90), respectively. The overall median postoperative survival time was 10.2 months in patients aged <70 years, while 11.2 months in patients aged ≥70 years (P=0.44). Except for age, there was no significant difference in new Katagiri score, revised Tokuhashi score, blood loss, operative time, and the rate of postoperative complications between the two groups. The median of PS was PS3 at baseline and improved to PS1 or PS2 at all postoperative timepoints in both groups. In addition, the mean value of BI greatly improved from <60 to >80 points and the mean score of EQ-5D improved from 0.0 to >0.7 points after surgery in both groups. These values were also maintained at least six months in both groups. Interestingly, there were no significant differences in PS, BI, and EQ-5D at all timepoints including baseline between the two groups. Furthermore, all of the PS, BI, and EQ-5D improved throughout the follow-up period in approximately 90% patients of each group. However, the improved PS, BI, and EQ-5D scores subsequently deteriorated in some patients and the rate of re-deterioration of EQ-5D was significantly higher in the patients aged ≥70 years than <70 years (P=0.03).

Conclusion

In the current study, palliative surgery for spinal metastasis improved PS, ADL, and QOL in the patients aged ≥70 years as well as <70 years. However, we should pay attention to the higher risk of re-deterioration of QOL in the elderly.