Assessing the Prognostic Impact of Body Composition Phenotypes on Surgical Outcomes and Survival in Spinal Metastasis Patients: A Deep Learning Approach to Preoperative CT Analysis
Resident University of Illinois at Chicago Chicago, IL, US
Disclosure(s):
Syed I. Khalid, MD: No financial relationships to disclose
Introduction: The prognostic significance of body composition phenotypes in patients undergoing surgical intervention for spinal metastases on patient survival has not yet been elucidated. This study aims to elucidate the impact of body composition phenotypes on surgical outcomes and 5-year survival.
Methods: The records of patients treated surgically for spinal metastases between 2010 and 2020 were retrospectively evaluated. A deep learning pipeline assessed preoperative CT scans obtained within three months of surgery and identified muscle and fat content and composition. This data was used to categorize patients into four body composition phenotypic groups: (1) Not Sarcopenic, Not Obese, (2) Sarcopenia Alone, (3) Obesity Alone, and (4) Sarcopenic Obesity (SO). Through a comprehensive propensity-matching procedure, our groups were matched. Rates of postoperative outcomes and survival were evaluated. Cox proportional hazard models were utilized to evaluate the influence of body composition phenotypes on 5-year survival. Kaplan-Meyer (KM) plots were used to evaluate survival probability further.
Results: Following a propensity matching procedure, 102 matched patient records were identified (Not Sarcopenic, Not Obese n=24, Sarcopenia Alone n=27, Obesity Alone n=37, and SO n=14). SO was found to be associated with a significantly increased risk of mortality within 60 months (HR 2.51, 95% CI 1.16-5.45). Kaplan-Meyer plots demonstrate evident divergence in survival probability within five years among the SO group compared to the others (Log-Rank p=0.022). Additionally, time to mortality was also lower in patients with SO (p=.018). Significant differences in postoperative ambulation rates were noted among patients with SO (p=.048), whereas no preoperative difference existed (p=0.12). No significant differences in postop disposition, length of stay, would-related complications, or inpatient medical complications were otherwise noted (p>.05).
Conclusion : The study identifies Sarcopenic Obesity as a distinct prognostic factor for increased mortality risk in patients undergoing surgery for spinal metastases, highlighting the complex interplay between body composition and patient outcomes. These findings advocate for integrating body composition analysis into preoperative assessment and tailored postoperative care strategies, promoting personalized treatment plans to improve survival and quality of life for this vulnerable patient population.