Abstract
BackgroundDetermination of the appropriateness of invasive management in patients with spinal metastatic disease requires accurate pre-operative estimation of survival. The purpose of this study was to examine serum alkaline phosphatase as a prognostic marker in spinal metastatic disease.MethodsChart reviews from two tertiary care centres were used to identify spinal metastatic disease patients. Bivariate and multivariate analyses were used to determine if serum alkaline phosphatase was an independent prognostic marker for survival.ResultsOverall, 732 patients were included with 90-day and 1-year survival of n = 539 (74.9%) and n = 324 (45.7%), respectively. The 1-year survival of patients in the first quartile of alkaline phosphatase (≤73 IU/L) was 78 (57.8%) compared to 31 (24.0%) for patients in the fourth quartile (>140 IU/L). Preoperative serum alkaline phosphatase levels were significantly elevated in patients with multiple spine metastases, non-spine bone metastasis, and visceral metastasis but not in patients with brain metastasis. On multivariate analysis, elevated serum alkaline phosphatase was identified as an independent prognostic factor for survival in spinal metastatic disease.ConclusionSerum alkaline phosphatase is associated with preoperative metastatic tumour burden and is a biomarker for overall survival in spinal metastatic disease.
Highlights
Determination of the appropriateness of invasive management in patients with spinal metastatic disease requires accurate pre-operative estimation of survival
Serum alkaline phosphatase is one such marker that is routinely collected in spinal metastatic disease patients but remains underutilised for prognostication
On multivariable logistic regression of 1-year mortality, serum alkaline phosphatase was an independent prognostic factor [Supplementary Table 6]. In this population of 732 patients undergoing intervention for spinal metastatic disease, serum alkaline phosphatase was significantly elevated in patients with multiple spinal metastases, other non-spine bone metastases, and visceral metastases but not in patients with brain metastases
Summary
Determination of the appropriateness of invasive management in patients with spinal metastatic disease requires accurate pre-operative estimation of survival. The purpose of this study was to examine serum alkaline phosphatase as a prognostic marker in spinal metastatic disease. Bivariate and multivariate analyses were used to determine if serum alkaline phosphatase was an independent prognostic marker for survival. Preoperative serum alkaline phosphatase levels were significantly elevated in patients with multiple spine metastases, non-spine bone metastasis, and visceral metastasis but not in patients with brain metastasis. On multivariate analysis, elevated serum alkaline phosphatase was identified as an independent prognostic factor for survival in spinal metastatic disease. Determination of the appropriateness of invasive management such as multi-level decompression and stabilisation requires accurate pre-operative estimation of survival.[4,5]. Serum alkaline phosphatase is one such marker that is routinely collected in spinal metastatic disease patients but remains underutilised for prognostication Determination of the appropriateness of invasive management such as multi-level decompression and stabilisation requires accurate pre-operative estimation of survival.[4,5] A number of prognostic factors have been identified in this population but routinely collected laboratory markers have yet to be fully understood or utilised.[5–7] Serum alkaline phosphatase is one such marker that is routinely collected in spinal metastatic disease patients but remains underutilised for prognostication
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