Gender and Sex Differences in Health-related Quality of Life, Clinical Outcomes and Survival after Treatment of Metastatic Spine Disease

C Rory Goodwin; Meghan Price; Andrea N Goodwin; Tara Dalton; Anne L Versteeg; Arjun Sahgal; Laurence D Rhines; James M Schuster; Michael H Weber; Aron Lazary; Stefano Boriani; Chetan Bettegowda; Michael G Fehlings; Paul M Arnold; Nicolas Dea; Raphaele Charest-Morin; John Shin; Ilya Laufer; Dean Chou; Ziya L Gokaslan; Michelle J Clarke; Charles G Fisher; Daniel M Sciubba; AO Spine Knowledge Forum Tumor

doi:10.1097/BRS.0000000000004910

Gender and Sex Differences in Health-related Quality of Life, Clinical Outcomes and Survival after Treatment of Metastatic Spine Disease

Spine (Phila Pa 1976). 2023 Dec 27. doi: 10.1097/BRS.0000000000004910. Online ahead of print.

Authors

C Rory Goodwin¹, Meghan Price¹, Andrea N Goodwin², Tara Dalton¹, Anne L Versteeg³, Arjun Sahgal⁴, Laurence D Rhines⁵, James M Schuster⁶, Michael H Weber⁷, Aron Lazary⁸, Stefano Boriani⁹, Chetan Bettegowda¹⁰, Michael G Fehlings¹¹, Paul M Arnold¹², Nicolas Dea¹³, Raphaele Charest-Morin¹³, John Shin¹⁴, Ilya Laufer¹⁵, Dean Chou¹⁶, Ziya L Gokaslan¹⁷, Michelle J Clarke¹⁸, Charles G Fisher¹³, Daniel M Sciubba¹⁹; AO Spine Knowledge Forum Tumor

Affiliations

¹ Department of Neurosurgery. Spine Division. Duke Center for Brain and Spine Metastasis. Duke University Medical Center, Durham, NC.
² Department of Sociology, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC.
³ Department of Orthopaedic Surgery, Division of Surgery, University of Toronto, Toronto, Ontario, Canada.
⁴ Department of Radiation Oncology, Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada.
⁵ Department of Neurosurgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
⁶ Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
⁷ Division of Surgery, McGill University and Montreal General Hospital, Montreal, Quebec, Canada.
⁸ National Center for Spinal Disorders and Buda Health Center, Budapest, Hungary.
⁹ IRCCS Istituto Ortopedico, Galeazzi, Milan, Italy.
¹⁰ Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD.
¹¹ Division of Neurosurgery and Spine Program, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada.
¹² Department of Neurosurgery, Carle Foundation Hospital, Urbana, IL.
¹³ Division of Spine, Department of Orthopaedics, University of British Columbia and Vancouver General Hospital, Vancouver, British Columbia, Canada.
¹⁴ Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
¹⁵ Department of Neurosurgery, Division of Spinal Neurosurgery, NYU Langone Health, New York, NY.
¹⁶ Department of Neurological Surgery, University of California San Francisco, San Francisco, CA.
¹⁷ Department of Neurosurgery, The Warren Alpert Medical School of Brown University and Rhode Island Hospital and The Miriam Hospital, Providence, RI.
¹⁸ Department of Neurosurgery, Mayo Clinic, Rochester, MN.
¹⁹ Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY.

PMID: 38149519
DOI: 10.1097/BRS.0000000000004910

Abstract

Study design: Retrospective review of prospective, multicenter and international cohort study.

Objective: To describe the effect of gender on HRQoL, clinical outcomes and survival for patients with spinal metastases treated with either surgery and/or radiation.

Summary of background data: Gender differences in health-related outcomes are demonstrated in numerous studies, with women experiencing worse outcomes and receiving lower standards of care than men, however, the influence that gender has on low health-related quality of life (HRQoL) and clinical outcomes after spine surgery remains unclear.

Methods: Patient demographic data, overall survival, treatment details, perioperative complications, and HRQoL measures including EQ-5D, pain NRS, the short form 36 version 2 (SF-36v2) and the Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ2.0) were reviewed. Patients were stratified by sex, and a separate sensitivity analysis that excluded gender-specific cancers (i.e., breast, prostate, etc.) was performed.

Results: The study cohort included 207 female and 183 male patients, with age, smoking status, and site of primary cancer being significantly different between the two cohorts (P<0.001). Both males and females experienced significantly improved SOSGOQ2.0, EQ-5D, and pain NRS scores at all study time points from baseline (P<0.001). Upon sensitivity analysis, (gender-specific cancers removed from analysis), the significant improvement in SOSGOQ physical, mental, and social subdomains and on SF-36 domains disappeared for females. Males experienced higher rates of postoperative complications. Kaplan-Meier survival analysis of both the overall and sensitivity analysis cohorts showed females lived longer than males after treatment (P=0.001 and 0.043, respectively).

Conclusion: Both males and females experienced significantly improved HRQoL scores after treatment, but females demonstrated longer survival and a lower complication rate. This study suggests that gender may be a prognostic factor in survival and clinical outcomes for patients undergoing treatment for spine metastases and should be taken into consideration when counseling patients accordingly.