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Multicenter Study
. 2025 Nov 15;50(22):1571-1580.
doi: 10.1097/BRS.0000000000005487. Epub 2025 Sep 3.

Effect of Preoperative Nutritional Status on Postoperative Clinical Outcomes of Patients With Metastatic Spinal Tumors: Japan Association of Spine Surgeons With Ambition Multicenter Study

Masafumi Kawai  1 , Satoshi Kato  1 , Noriaki Yokogawa  1 , Takaki Shimizu  1 , Satoru Demura  1 , Yuki Shiratani  2 , Akinobu Suzuki  3 , Koji Tamai  3 , Kenichiro Kakutani  4 , Yutaro Kanda  4 , Hiroyuki Tominaga  5 , Ichiro Kawamura  5 , Masayuki Ishihara  6 , Masaaki Paku  6 , Toru Funayama  7 , Kousei Miura  7 , Eiki Shirasawa  8 , Hirokazu Inoue  9 , Atsushi Kimura  10 , Kazuo Nakanishi  11 , Hirokatsu Sawada  12 , Koji Matsumoto  12 , Masahiro Funaba  13 , Hidenori Suzuki  13 , Koji Akeda  14 , Norihiko Takegami  14 , Takuya Iimura  15 , Hiroshi Moridaira  15 , Hideaki Nakajima  16 , Tsutomu Oshigiri  17 , Takashi Hirai  18 , Bungo Otsuki  19 , Kazu Kobayakawa  20 , Haruki Funao  21 , Koji Uotani  22 , Shinji Tanishima  23 , Koichi Sairyo  24 , Ko Hashimoto  25 , Chizuo Iwai  26 , Shoji Seki  27 , Masashi Miyazaki  28 , Kazuyuki Watanabe  29 , Toshio Nakamae  30 , Takashi Kaito  31 , Hiroaki Nakashima  32 , Narihito Nagoshi  33 , Shiro Imagama  32 , Kota Watanabe  33 , Gen Inoue  8 , Takeo Furuya  2 ; JASA Study Group
Affiliations
Multicenter Study

Effect of Preoperative Nutritional Status on Postoperative Clinical Outcomes of Patients With Metastatic Spinal Tumors: Japan Association of Spine Surgeons With Ambition Multicenter Study

Masafumi Kawai et al. Spine (Phila Pa 1976). .

Abstract

Study design: A multicenter prospective study.

Objective: To evaluate the effect of preoperative nutritional status, assessed using the prognostic nutritional index (PNI), on clinical outcomes, including survival prognosis, postoperative complications, hospitalization duration, and functional prognosis, in patients with metastatic spinal tumors undergoing surgery.

Summary of background data: Malnutrition is common in patients with cancer and is associated with poor clinical outcomes. However, data on the role of nutritional status in metastatic spinal tumors are limited.

Methods: We included 309 patients who underwent surgery for metastatic spinal tumors between October 2018 and March 2021. Patients were divided into two groups: normal nutrition (PNI ≥40) and malnutrition (PNI <40). Clinical outcomes, including 1-year mortality, postoperative complications, and functional improvements (performance status, Frankel grade, Barthel index, vitality index, and EuroQol 5-dimension 5-level), were compared using propensity score matching to adjust for confounding factors, such as age, sex, preoperative chemotherapy, performance status, primary tumor type, and visceral metastases.

Results: Thirty-six percent of patients were malnourished. After propensity score matching, the malnutrition group had a significantly higher mortality rate within 1 year than the normal nutrition group (55% vs. 31%, P <0.001) and showed limited physical improvement, including neurological recovery, one month postoperatively. However, improvements in motivation and quality of life (QOL) were comparable between the groups, and physical function recovery at six months was similar. No significant differences in postoperative complications or length of hospital stay were observed between the groups.

Conclusions: Preoperative malnutrition was observed in 36% of patients with metastatic spinal tumors who underwent surgery and was associated with a poor postoperative survival prognosis and delayed physical recovery. However, surgical treatment improved motivation, QOL, and physical function six months after surgery. These findings highlight the importance of assessing the nutritional status preoperatively and considering both survival and functional prognoses when selecting surgical treatment for patients with malnutrition.

Keywords: Barthel index; malnutrition; metastatic spinal tumors; neurological outcome; postoperative complications; prognostic nutritional index (PNI); propensity score matching; quality of life; surgical treatment; survival prognosis.

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Conflict of interest statement

The authors report no conflicts of interest.

References

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