Risk factors for survival of 106 surgically treated patients with symptomatic spinal epidural metastases

Abstract

Purpose Evaluation of risk factors for survival in patients surgically treated for symptomatic spinal epidural metastases (SEM). Methods One hundred and six patients who were surgically treated for symptomatic SEM in a 10-year period in two cooperatively working hospitals were retrospectively studied for nine risk factors: age, gender, site of the primary tumor, location of the symptomatic spinal metastasis, functional and neurologic status, the presence of visceral metastases and the presence of other spinal and extraspinal bone metastases. Analysis was performed using the KaplanMeier method, univariate log-rank tests and Cox-regression models. Results Overall median survival was 10.7 months (0.2-107.5 months). Overall 30-day complication rate was 33 %. Multivariate Cox-regression analysis showed that fast growing primary tumors (HR 3.1, 95 % CI 1.6-6.2, p = 0.001), the presence of visceral metastases (HR 1.7, 95 % CI 1.0-2.9, p = 0.033) and a low performance status (HR 2.7, 95 % CI 1.1-6.6, p = 0.025) negatively influenced the survival. Conclusion Primary tumor type, presence of visceral metastases and performance status are significant predictors for survival after surgery for symptomatic SEM and should be evaluated before deciding on the extent of treatment. More accurate prediction models are needed to select the best treatment option for the individual patient.

Tokuhashi score and other prognostic factors in 260 patients with surgery for vertebral metastases

“…Also of importance are the benefits expected by the patient and the risk of complications, as postoperative complications can cause rapid deterioration in these fragile patients [10][11][12]. Survival in patients with spinal metastases has therefore been the focus of numerous studies, which produced variable results.…”

“…Their median survival was 84 months (95% CI, 41-96). Palliative surgery was performed in 243 patients, whose median survival was 9 months (95% CI, [8][9][10][11]. The survival curves differed significantly between these two groups (P < 0.0001).…”

“…Table 3 reports predicted and observed survivals. Observed median survival in the 0-8, 9-11, and 12-15 Tokuhashi score groups was 5 months (95% CI, 3-6), 10 months (95% CI, [8][9][10][11][12][13][14][15][16][17][18][19], and 36 months (95% CI, 30-54), respectively. Fig.…”

Predictors of 30- and 90-Day Survival Following Surgical Intervention for Spinal Metastases

“…[1][2][3][4][5][6][7][8][9][10]13,14,15,19,20 Several studies have indicated that surgery is more advantageous than nonoperative measures in terms of functional outcome, pain control, and preservation of ambulatory capacity. 1,2,8,9 Invariably, not all patients with spinal metastases can benefit from a surgical procedure, especially as such interventions may be physiologically taxing to oncology patients and are known to carry moderately high rates of postoperative morbidity.…”

Application of morphometric analysis to patients with lung cancer metastasis to the spine: a clinical study

“…While surgery can improve overall survival and neurological outcome, and provide pain control, these procedures delay cancer treatments (chemotherapy and radiation) and are resource intensive. 3,14,18,21,22,51 Surgical risk is also high, with postoperative morbidity as high as 76%, 7 which may diminish any benefit of surgery and hasten patient demise.…”