Spinal metastases from solid tumors. Analysis of factors affecting survival

Abstract

Background. Factors affecting survival were determined for 109 patients with thoracic spine metastases and cord compression. Lung, prostate, and breast were the most common primary sites (78%). All patients had surgical decompression of the spinal cord, and 99% received radiotherapy. Methods. Survival was determined based on anatomic site of primary carcinoma, preoperative neurologic deficit, extent of disease, number of vertebral bodies involved, tumor location (site of cord compression), and age. The respective compounding weight of the negative prognostic factors also was analyzed in terms of survival. Results. The overall median survival was 10 months. Patients preoperatively ambulatory survived statistically significantly longer than nonambulatory patients or those with sphincter incontinence (P = 3.469 × 10−6). Patients with renal cell carcinoma survived the longest, followed by those with breast, prostate, lung, and colon cancer. Patients with breast cancer survived statistically longer than those with lung cancer (P = 0.039). Patients with one vertebral body involved survived statistically significantly longer than patients with multiple vertebral level involvement (P = 0.027). Extent of disease, age, and tumor location did not significantly influence survival. In patients with vertebral column disease, the presence of two or more poor prognostic indicators (leg strength 0/5‐3/5, lung or colon cancer, multiple vertebral body involvement), had a compounding adverse effect on survival. Conclusions. For patients with spinal metastases and cord compression, the factors found to affect survival include preoperative neurological status, anatomic site of primary carcinoma, and number of vertebral bodies involved. Patients with vertebral column disease and two or more of the poor prognostic indicators have a short life expectancy, and, therefore, radical surgery is not recommended because the benefits may not be substantial.

Clinical outcome and survival after palliative surgery for spinal metastases

“…Because these patients were selected for surgery, their general condition was better than that of patients who were not surgical candidates. Conversely, our finding that the EOD of patients with spinal metastases is not an independent predictor of survival concurs with the results of Sioutos et al 28 Age, gender, preoperative urinary disturbance, synchronous distant metastases, and single-modality adjuvant therapy (only chemotherapy or radiotherapy) were not statistically significant prognostic parameters for our patients. Treatment of the primary tumors before surgery was not a statistically significant factor for prediction of overall survival.…”

Accuracy of the revised Tokuhashi score in predicting survival in patients with metastatic spinal cord compression (MSCC)

“…The revised Tokuhashi score is considered to be a reasonable tool for predicting the prognosis of patients' life expectancy as has been confirmed by numerous authors [8][9][10][11][12][13][14]. In a retrospective review of 246 patients, Tokuhashi and colleagues showed a predictive value of 85.3 % in the group with a score of 0-8, 73.1 % with a score of 9-11 and 95.4 % in the 12-15 group.…”

“…This improved survival following surgical intervention was also seen by Majeed et al [13] in their relatively small series of 55 patients. Surgery has a positive impact on improvement in patients' neurological status and Sioutos et al [14] demonstrated that patients who were ambulatory pre-operatively and those with only one vertebral involvement survived statistically longer than patients who were non-ambulatory and with multilevel disease.…”

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

“…Several scoring systems have been proposed to assess survival prognosis for spinal metastasis after surgery or radiotherapy alone [8][9][10][11]. However, (1) the number of patients with lung cancer in those studies is very low, making it difficult to draw conclusions on this specific tumor type; (2) postoperative function outcome is not considered in all of those studies; (3) some old and commonly used scoring systems have underestimated the life expectancy of patients with spinal metastases of lung cancer due to the increased survival time for those patients in recent years [12,13].…”