Is Ambulatory Status a Prognostic Factor of Survival in Patients with Spinal Metastases? An Exploratory Meta‐analysis

Abstract

This study was conducted to identify the influence of ambulatory status prior to treatment on survival of patients with spinal metastases. Two investigators independently retrieved relevant electronic literature in PubMed, Embase, and Cochrane Library databases, to identify eligible studies. Effect estimates for hazard risk (HR) were extracted and synthesized through fixed-effects or random-effects models as appropriate. A total of 17 eligible studies were identified, with an accumulated number of 3962 participants. HR from 14 studies regarding comparison between ambulatory versus non-ambulatory groups were pooled using a random-effects model, and statistical significance was presented for the pooled HR (HR = 1.96; 95% confidence interval [CI], 1.65-2.34). In subgroups of mixed primary tumor and lung cancer, ambulatory status was considered to be a significant prognostic factor (P < 0.05), while in the subgroup of prostate cancer it was not (HR = 1.72; 95% CI, 0.79-3.74). HR from 4 studies related to comparison between Frankel E versus Frankel C-D were pooled using a fixed-effects model, which revealed statistical significance (HR = 1.73; 95% CI, 1.27-2.36). Ambulatory status is a significant prognostic factor in patients with spinal metastases. However, in patients with primary prostate cancer, the prognostic effect of ambulatory status has not yet been confirmed to be significant.

Prognosis after Palliative Surgery for Patients with Spinal Metastasis: Comparison of Predicted and Actual Survival

“…Preoperative ambulatory status has been identified as a significant prognostic factor in patients with spinal metastases in a meta–analysis, with the suggestion that this status should be considered when choosing the treatment modality [ 30 ]. In the current study, the preoperative Frankel grade differed significantly between patients with and without survival for >6 months in univariate analysis; however, no significant difference was observed in the survival period between nonambulatory (Frankel A–C) and ambulatory (Frankel D and E) cases.…”

Cost-Utility Analysis Compared Between Radiotherapy Alone and Combined Surgery and Radiotherapy for Symptomatic Spinal Metastases in Thailand

“…However, the survival rate was not only affected by the choice of treatment but also other factors were included, so the highly selection of spinal metastatic patients who seemed to have better prognosis and outcome after the treatment was required. One of the significant prognostic factors in spinal metastasis patients was reported to be ambulatory status [ 21 ]. Schoenfeld et al [ 9 ] reported a QALY of 0.800 among patients who received nonoperative treatment, and a QALY of 0.823 in patients with independent ambulatory status at presentation.…”

Visceral Metastasis: A Prognostic Factor of Survival in Patients with Spinal Metastases

“…Thus, decompressive surgery is not indicated for patients with a severely limited lifespan for only a few weeks, while supportive care or radiotherapy is appropriate. Therefore, life expectancy drives treatment regimens for spinal metastasis.…”