Application of morphometrics as a predictor for survival in female patients with breast cancer spinal metastasis: a retrospective cohort study

Hesham Mostafa Zakaria, Lara Massie, Azam Basheer, David Boyce-Fappiano, Erinma Elibe, Lonni Schultz, Ian Lee, Brent Griffith, Farzan Siddiqui, Victor Chang

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Background Context: The current standard of care for prediction of survival of cancer staging is based on TNM staging. However, for patients with spinal metastasis, who all have identical stage IV disease, identifying accurate prognostic markers of survival would allow better treatment stratification between more aggressive treatment strategies or palliation. Analytical morphometrics enables physicians to quantify patient frailty by measuring lean muscle mass. Morphometrics also predicts survival in patients with lung cancer metastases to the spine. Purpose: Our study evaluates whether morphometrics is predictive of survival in patients with breast cancer spinal metastasis. Design: This is an observational retrospective cohort study. Patient Sample: This study includes female patients with breast cancer spinal metastases and patients who have undergone stereotactic body radiation therapy. Outcome Measures: Overall survival was the primary outcome measure. Methods: Morphometric measurements of the psoas muscle were taken using computed tomography scans of the lumbar spine. We then stratified patients into tertiles based on the psoas muscle area. Results: We identified 118 patients, with a median survival of 104 days (95% confidence interval [CI]=73–157 days). Overall survival was not associated with age, chemotherapy, or number of levels radiated. Patients in the lowest tertile of psoas size had significantly shorter survival compared with the highest tertile (68 days versus 148 days, hazard ratio 1.76 [95% CI=1.08–2.89], p=.024). The shorter survival was also true for the lowest tertile versus the middle tertile (68 days versus 167 days, hazard ratio 1.95 [95% CI=1.19–3.19], p=.007). Kaplan-Meier survival curves were used to visually illustrate the differences in survival between different tertiles. Conclusions: Morphometric analysis of the psoas muscle size in patients with breast cancer metastases to the spine was effective in identifying patients at risk of shorter survival. Further research is needed to validate these results, as well as to see if these methodologies can be applied to other cancer histologies.

Original languageEnglish (US)
Pages (from-to)1798-1803
Number of pages6
JournalSpine Journal
Issue number10
StatePublished - Oct 2018
Externally publishedYes


  • Breast cancer mortality
  • Frailty index
  • Morphometric analysis
  • Morphometrics
  • Oncological outcomes
  • Spinal metastases
  • Spine complications
  • Spine surgery
  • Stage IV breast cancer

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology


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