Survival analysis in patients with metastatic spinal disease: the influence of surgery, histology, clinical and neurologic status

Abstract

The spine is the most common site for skeletal metastasis in patients with malignancy. Approximately half of all patients with an advanced malignancy have evidence of spinal involvement. Surgical treatment remains a source of debate, and prognostic factors need to be well established to allow an appropriate decision regarding treatment modalities 1,2,3,4,5 .Vertebral involvement in such patients is associated with worse morbidity and mortality rates, impairing prognosis. Quantification of vertebral involvement, vertebral canal invasion, neurological status, general health status, and malignancy prognosis determined by primary tumor histology are paramount factors for surgical planning and definition of therapeutic targets 6,7,8,9,10 .We conducted a survival analysis in a sample of patients with metastatic spinal disease to determine factors associated with survival. METHODThe study sample consisted of patients with vertebral metastases consecutively admitted from July 2010 to January ABSTRACTSpine is the most common site for skeletal metastasis in patients with malignancy. Vertebral involvement quantification, neurological status, general health status and primary tumor histology are factors to set surgical planning and therapeutic targets. We evaluated the impact of general clinical and neurological status, histologic type and surgery in survival. Method: The study sample consisted of consecutive patients admitted from July 2010 to January 2013 for treatment. Results: Sixty eight patients were evaluated. 23 were female and 45 were male. Main primary neoplasic sites were: breast, prostate, lung/pleura and linfoproliferative. Thirty three out of 68 received surgical treatment, 2 received percutaneous biopsy and 33 had nonsurgical treatment. Survival: Log Rank curves revealed no statistical significant difference according to histological type, surgical approach and Frankel Score. Karnofsky Score was statistically different. Conclusion: Histological type and clinical status were statistically associated with life expectancy in vertebral metastatic disease.Keywords: neoplasm metastasis, spinal diseases, prognosis. RESUMOA coluna vertebral é o sítio mais comum de metastases ósseas. A quantificação do acometimento vertebral, o status neurológico, status clínico e histologia do tumor primário são fatores importantes para planejamento cirúrgico e metas terapêuticas. Nós avaliamos o impacto do status clinico geral e neurológico, tipo histológico e cirurgia na sobrevida de pacientes com metástases espinhais. Método: A amostra consistiu de pacientes consecutivamente admitidos de Julho de 2010 a Janeiro de 2013. Resultados: Sessenta e oito pacientes foram avaliados. 23 eram mulheres e 45 eram homens. Os principais sítios primários foram mama, próstata, pulmão e linfoproliferativos. Trinta e três realizaram tratamento cirúrgico, 2 realizaram biópsia percutânea e 33 tiveram tratamento conservador e radioterapia. Conclusão: As curvas Log Rank não revelaram significância quanto à cirurgia e escore de Frankel, mas revelaram as...

Classification and scoring systems for metastatic spine tumors: a literature review

“…Therefore, the outcomes of their patients were considerably poorer compared with those of the patients used for the preparation of other scoring systems 2) . Recent reviews have suggested 1) the function status, 2) number of visceral metastases, and 3) primary tumor pathology as factors that exert the greatest effects on outcome [65][66][67] . Moreover, presently, treatment for metastasis is initiated as soon as asymptomatic metastasis is detected.…”

Метастазы В Позвоночник При Раке Легкого

“…В целом позвоночный ствол при РЛ является наиболее уязвимым местом костно-го метастазирования среди всех локализацией в ске-лете [18], а признаки метастатической спондилопатии иногда являются первым манифестным проявлением заболевания [17]. При этом сдавление спинного мозга отмечается у 25-30 % от числа таких пациентов [21].…”

Automatic segmentation of the spine by means of a probabilistic atlas with a special focus on ribs suppression

“…However, this complex structure is subject to a wide variety of diseases that can damage the vertebrae or surrounding tissues changing the structure of the spine and causing, in most of the cases, back pain . Moreover, metastases to the spine represent an important problem in patients with cancer . For nearly half of all advanced cancer patients there is evidence of spinal involvement, associating the vertebral bodies with the highest morbidity and mortality rates …”

“…Moreover, metastases to the spine represent an important problem in patients with cancer . For nearly half of all advanced cancer patients there is evidence of spinal involvement, associating the vertebral bodies with the highest morbidity and mortality rates …”

“…1 Moreover, metastases to the spine represent an important problem in patients with cancer. 2 For nearly half of all advanced cancer patients there is evidence of spinal involvement, associating the vertebral bodies with the highest morbidity and mortality rates. 2 Nowadays, spinal imaging studies are increasing worldwide, 3 being Computed Tomography (CT) and Magnetic Resonance imaging (MRI) two of the most common modalities used for the diagnosis of spinal disease.…”