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. 2017 Feb 22;12(2):e0171507.
doi: 10.1371/journal.pone.0171507. eCollection 2017.

Symptomatic spinal metastasis: A systematic literature review of the preoperative prognostic factors for survival, neurological, functional and quality of life in surgically treated patients and methodological recommendations for prognostic studies

Anick Nater  1 , Allan R Martin  1 , Arjun Sahgal  2 , David Choi  3 , Michael G Fehlings  1   4
Affiliations

Symptomatic spinal metastasis: A systematic literature review of the preoperative prognostic factors for survival, neurological, functional and quality of life in surgically treated patients and methodological recommendations for prognostic studies

Anick Nater et al. PLoS One. .

Abstract

Purpose: While several clinical prediction rules (CPRs) of survival exist for patients with symptomatic spinal metastasis (SSM), these have variable prognostic ability and there is no recognized CPR for health related quality of life (HRQoL). We undertook a critical appraisal of the literature to identify key preoperative prognostic factors of clinical outcomes in patients with SSM who were treated surgically. The results of this study could be used to modify existing or develop new CPRs.

Methods: Seven electronic databases were searched (1990-2015), without language restriction, to identify studies that performed multivariate analysis of preoperative predictors of survival, neurological, functional and HRQoL outcomes in surgical patients with SSM. Individual studies were assessed for class of evidence. The strength of the overall body of evidence was evaluated using GRADE for each predictor.

Results: Among 4,818 unique citations, 17 were included; all were in English, rated Class III and focused on survival, revealing a total of 46 predictors. The strength of the overall body of evidence was very low for 39 and low for 7 predictors. Due to considerable heterogeneity in patient samples and prognostic factors investigated as well as several methodological issues, our results had a moderately high risk of bias and were difficult to interpret.

Conclusions: The quality of evidence for predictors of survival was, at best, low. We failed to identify studies that evaluated preoperative prognostic factors for neurological, functional, or HRQoL outcomes in surgical patients with SSM. We formulated methodological recommendations for prognostic studies to promote acquiring high-quality evidence to better estimate predictor effect sizes to improve patient education, surgical decision-making and development of CPRs.

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Conflict of interest statement

Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: Dr. Michael Fehlings has consulting agreements with Zimmer Biomet, InVivo Therapeutics, and Pfizer. Dr. Arjun Saghal has given educational seminars with Medtronic, Elekta AB, Accuray Inc., and Varian medical systems; acted in a consulting or advisory role with Varian medical systems, Hoffmann-La Roche Limited; has been awarded research grants from Elekta AB; has received travel accommodations and expenses from Medtronic, Elekta and Varian; and belongs to the Elekta MR Linac Research Consortium. There are no patents, products in development, or marketed products to declare. This does not alter the authors’ adherence to all PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Study selection process.
See this image and copyright information in PMC

References

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