Prognostic Relevance of Clinical Symptoms in Patients with Spinal Metastases

Hosono, Noboru; Ueda, Takafumi; Tamura, Daisuke; Aoki, Yasuaki; Yoshikawa, Hiroyuki

doi:10.1097/01.blo.0000160003.70673.2a

Cited by 62 publications

(54 citation statements)

References 16 publications

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“…Furthermore, it is well established that neurological deficits from spinal metastases result in poorer prognosis. 14,30,37,38 The negative association between the occurrence of postoperative complications and postoperative survival is also not surprising. Both the association observed between preoperative embolization and fewer postoperative complications, and the association between longer posterior constructs and greater postoperative complications, are intuitive.…”

Section: Discussionmentioning

confidence: 99%

“…Hosono et al reported on factors that influenced survival in 165 patients who underwent surgery for spinal metastasis, 15 of which were from the thyroid, and found that favorable histology, absence of paresis, and absence of pain were all associated with improved overall survival. 14 Matsumoto et al reported on 8 patients who underwent total en bloc spondylectomy for thyroid metastases, all of whom improved at least one Frankel grade at the 1-year follow-up examination. 19 The finding that progressive systemic disease is associated with worse overall survival is not surprising.…”

Section: Discussionmentioning

confidence: 99%

“…The levels above and below the vertebrectomy site were counted as parts of the anterior column construct when plating, Steinmann pins, or chest tube insertion were involved. Fourteen patients did not require posterolateral stabilization; of those who did, the median length of the construct was 6 vertebral levels (range [3][4][5][6][7][8][9][10][11][12][13][14]. Two patients underwent lumbopelvic or lumbosacropelvic fixation; in these instances, the sacrum or pelvis was treated as 1 level.…”

Section: Operative Datamentioning

confidence: 99%

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Factors affecting survival in 43 consecutive patients after surgery for spinal metastases from thyroid carcinoma

Sellin

Suki

Harsh

et al. 2015

SPI

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OBJECT Spinal metastases account for the majority of bone metastases from thyroid cancer. The objective of the current study was to analyze a series of consecutive patients undergoing spinal surgery for thyroid cancer metastases in order to identify factors that influence overall survival. METHODS The authors retrospectively reviewed the records of all patients who underwent surgery for spinal metastases from thyroid cancer between 1993 and 2010 at the University of Texas MD Anderson Cancer Center. RESULTS Forty-three patients met the study criteria. Median overall survival was 15.4 months (95% CI 2.8–27.9 months) based on the Kaplan-Meier method. The median follow-up duration for the 4 patients who were alive at the end of the study was 39.4 months (range 1.7–62.6 months). On the multivariate Cox analysis, progressive systemic disease at spine surgery and postoperative complications were associated with worse overall survival (HR 8.98 [95% CI 3.46–23.30], p < 0.001; and HR 2.86 [95% CI 1.30–6.31], p = 0.009, respectively). Additionally, preoperative neurological deficit was significantly associated with worse overall survival on the multivariate analysis (HR 3.01 [95% CI 1.34–6.79], p = 0.008). Conversely, preoperative embolization was significantly associated with improved overall survival on the multivariate analysis (HR 0.43 [95% CI 0.20–0.94], p = 0.04). Preoperative embolization and longer posterior construct length were significantly associated with fewer and greater complications, respectively, on the univariate analysis (OR 0.24 [95% CI 0.06–0.93] p = 0.04; and OR 1.24 [95% CI 1.02–1.52], p = 0.03), but not the multivariate analysis. CONCLUSIONS Progressive systemic disease, postoperative complications, and preoperative neurological deficits were significantly associated with worse overall survival, while preoperative spinal embolization was associated with improved overall survival. These factors should be taken into consideration when considering such patients for surgery. Preoperative embolization and posterior construct length significantly influenced the incidence of postoperative complications only on the univariate analysis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Operative Datamentioning

confidence: 99%

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Factors affecting survival in 43 consecutive patients after surgery for spinal metastases from thyroid carcinoma

Sellin

Suki

Harsh

et al. 2015

SPI

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“…This system was constructed from retrospective data of 67 patients between 1987 and 1991, and the prognostic factors were given weighted scores after assessment of their statistical hazard ratios. The histology of the primary tumour correlates well with survival in both surgical patients [7,10,24,25] and medical cohorts [25][26][27][28], with longer survival times seen in patients with myeloma, breast, prostate and thyroid cancers. The primary tumour type was, therefore, given more weight in the scoring system of Tomita et al [7].…”

Section: Scoring and Classification Systemsmentioning

confidence: 99%

“…However, as far as possible, it is still important to ensure that clinical practice of surgeons is influenced by a strong evidence base. Hosono et al studied a large retrospective series of patients with spinal metastasis, and concluded ''a large prospectively designed study of consecutive patients is essential to screen the possible prognostic factors in patients with spinal metastases'' [25]: a viewpoint which we strongly advocate. …”

Section: Recommendations Of the Gstsgmentioning

confidence: 99%

Review of metastatic spine tumour classification and indications for surgery: the consensus statement of the Global Spine Tumour Study Group

et al. 2009

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Choosing the right operation for metastatic spinal tumours is often difficult, and depends on many factors, including life expectancy and the balance of the risk of surgery against the likelihood of improving quality of life. Several prognostic scores have been devised to help the clinician decide the most appropriate course of action, but there still remains controversy over how to choose the best option; more often the decision is influenced by habit, belief and subjective experience. The purpose of this article is to review the present systems available for classifying spinal metastases, how these classifications can be used to help surgical planning, discuss surgical outcomes, and make suggestions for future research. It is important for spinal surgeons to reach a consensus regarding the classification of spinal metastases and surgical strategies. The authors of this article constitute the Global Spine Tumour Study Group: an international group of spinal surgeons who are dedicated to studying the techniques and outcomes of surgery for spinal tumours, to build on the existing evidence base for the surgical treatment of spinal tumours.

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Development of a model with which to predict the life expectancy of patients with spinal epidural metastasis

Bartels¹,

Feuth²,

Maazen³

et al. 2007

Cancer

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BACKGROUND.The surgical treatment of spinal epidural metastasis is evolving. To be a surgical candidate, a patient should have a life expectancy of at least 3 months. Estimation of survival by experienced specialists has proven to be unreliable.METHODS.The Cox proportional hazards model was used to make a prediction model. To validate the model, Efron optimism correction by bootstrapping was performed. Retrospective data of patients treated for a spinal metastasis were used. Possible predictive factors were defined based on clinical experience and the literature. Statistical methods and clinical knowledge were also used to reveal an optimal set of predictors of survival. Data from patients treated at the Department of Radiation Oncology for spinal metastasis between 1998 and 2005 were evaluated.RESULTS.The case notes of 219 patients form the base of this study. In the final model, only 5 variables were required to predict the survival of a patient with spinal metastasis: sex, location of the primary lesion, intentional curative treatment of the primary tumor, cervical location of the spinal metastasis, and Karnofsky performance score. Examples with different predictors are given. The R index of Nagelkerke was 0.36 (95% confidence interval [95% CI], 0.28–0.48) and the c‐index 0.72 (95% CI, 0.68–0.77).CONCLUSIONS.A reliable and simple model with which to predict the survival of a patient with spinal epidural metastasis is presented. Without the need for extensive investigations, survival can be predicted and only 5 easily obtainable parameters are required. Cancer 2007. © 2007 American Cancer Society.

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Prognostic Relevance of Clinical Symptoms in Patients with Spinal Metastases

Cited by 62 publications

References 16 publications

Factors affecting survival in 43 consecutive patients after surgery for spinal metastases from thyroid carcinoma

Factors affecting survival in 43 consecutive patients after surgery for spinal metastases from thyroid carcinoma

Review of metastatic spine tumour classification and indications for surgery: the consensus statement of the Global Spine Tumour Study Group

Development of a model with which to predict the life expectancy of patients with spinal epidural metastasis

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