A validated preoperative score predicting survival and functional outcome in lung cancer patients operated with posterior decompression and stabilization for metastatic spinal cord compression

Abstract

Purpose This study aims to create and validate a score for survival and functional outcome of lung cancer patients with metastatic spinal cord compression (MSCC) after posterior decompressive surgery. Methods The entire cohort of 73 consecutive patients was randomly assigned to a test group (N = 37) and a validation group (N = 36). In the test group, we retrospectively analyzed 10 preoperative characteristics. Characteristics significantly associated with survival on multivariate analysis were included in the score. Patients in the validation group were used to confirm whether the score was reproducible. Postoperative functional outcome was analyzed both in the test and validation groups. Results On multivariate analysis, preoperative ambulatory status (P = 0.0017), visceral metastases (P = 0.0002), and time developing motor deficits (P = 0.0004) had significant impact on survival and were included in the scoring system. According to the prognostic scores, which ranged from 0 to 6 points, two risk groups were designed: 0-2 and 3-6 points and the median survival was 2.6 months (95 % CI, 1.0-3.8 months) and 10.7 months (95 % CI, 7.1-13.7 months), respectively (P \ 0.0001). In the validation group, the corresponding median survival was 2.7 months (95 % CI, 1.6-5.5 months) and 10.8 months (5.8-13.6 months), respectively (P \ 0.0001). In addition, the functional outcome was worse in patients with 0-2 points than in patients with 3-6 points both in the test (P = 0.0023) and validation groups (P = 0.0298). Conclusion Patients with scores of 0-2 points, who have short survival time (life expectancy less than 3 months) and poor functional outcome, appear best treated with radiotherapy or best supportive care alone. Surgery may be no longer in consideration in most of the patients in this group. Patients with score of 3-6 points should be surgical candidates, because survival prognosis (life expectancy more than 10 months) and functional outcome are favorable after surgery.

Decompression surgery for spinal metastases: a systematic review

“…2,3,5,7,15,18,19,21,25,28,[30][31][32]34,35,37,38,40,43 Of these, 16 studies were retrospective; 1 was a longitudinal observational study; 1 was a randomized, multiinstitutional, nonblinded trial; and 1 was a semiprospective study that included both retrospectively and prospectively collected data. Surgical interventions included decompression with and without instrumentation and radiotherapy.…”

“…7 Additionally, the authors noted that KPS was the strongest predictor of survival in the their hormonerefractory patients. 7 Lei et al 21 sought to establish a scoring system for survival and functional outcome among patients undergoing posterior decompression surgery for lung cancer metastatic to the spine. The authors found that preoperative ambulatory status (p < 0.01), visceral metastases (p < 0.001), and time to developing motor deficits (p < 0.001) were significant predictors of survival and were therefore included in the scoring system.…”

“…The authors found that preoperative ambulatory status (p < 0.01), visceral metastases (p < 0.001), and time to developing motor deficits (p < 0.001) were significant predictors of survival and were therefore included in the scoring system. 21 In a separate study, Lei et al 19 also created a scoring system to predict survival prognosis among patients with metastatic non-small cell lung cancer causing spinal cord compression who underwent surgical decompression. The authors included the following components as part of their scoring system: ECOG performance status (p = 0.02), number of involved verte- The median postop survival time did not significantly decrease w/ an increasing no.…”

“…5,6,12,17,21,34,36,41 Seven studies were retrospective and one was a nonrandomized, prospective study. The 7 retrospective studies used different decompression techniques, and the prospective study used a minimally invasive approach.…”

New imaging characteristics for predicting postoperative neurologic status in patients with metastatic epidural spinal cord compression. A retrospective analysis of 81 cases

“…Predicting functional outcome is of great importance when selecting the appropriate treatment in MESCC patients [14][15][16].…”