The impact of sarcopenia on surgical and oncologic outcomes in surgically treated patients with metastatic bone disease.

BACKGROUND

Sarcopenia has been correlated with mortality in several orthopaedic conditions; however, its impact has not been evaluated in the setting of extremity metastatic bone disease. This study evaluates the influence of sarcopenia on surgical and oncologic outcomes in these patients.

METHODS

A retrospective cohort study included patients surgically treated for biopsy-proven metastatic bone disease or myeloma from 2011 to 2020. Demographics, imaging findings, and survival outcomes were collected. The psoas lumbar vertebral index (PLVI) was calculated by dividing the mean psoas cross-sectional area by the CSA of the fourth lumbar vertebra (L4). Patients were classified into low (sarcopenic) and high PLVI groups using a median PLVI cutoff (0.78) and further subgroups based on 1 SD from the mean. Survival was analyzed using Kaplan-Meier curves and log-rank tests.

RESULTS

94 patients were included, with a mean age of 66.1 years. Sarcopenia (low PLVI) correlated with lower 3-month survival following surgical treatment (p = 0.02). PLVI subgroups showed significant survival differences with worse survival in low PLVI (p = 0.024). Male sex increased 1-year mortality risk (HR: 2.092, p = 0.029), while higher PLVI was protective for 3-month and 1-year mortality.

CONCLUSION

Lower PLVI is associated with increased mortality risk after surgery for extremity metastases. This information can inform surgical decision making and patient counseling.