Surgery on spinal epidural metastases (SEM) in renal cell carcinoma: a plea for a new paradigm

Bakker, Nicolaas A.; Coppes, Maarten H.; Vergeer, Rob A; Kuijlen, Jos M. A.; Groen, Rob J. M.

doi:10.1016/j.spinee.2014.04.013

Cited by 10 publications

(15 citation statements)

References 9 publications

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“…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.…”

Section: Predictors Of Survivalmentioning

confidence: 99%

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Decompression surgery for spinal metastases: a systematic review

Bakar

Tanenbaum

Phan

et al. 2016

FOC

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OBJECTIVE The aim of this study was to systematically review the literature on reported outcomes following decompression surgery for spinal metastases. METHODS The authors conducted MEDLINE, Scopus, and Web of Science database searches for studies reporting clinical outcomes and complications associated with decompression surgery for metastatic spinal tumors. Both retrospective and prospective studies were included. After meeting inclusion criteria, articles were categorized based on the following reported outcomes: survival, ambulation, surgical technique, neurological function, primary tumor histology, and miscellaneous outcomes. RESULTS Of the 4148 articles retrieved from databases, 36 met inclusion criteria. Of those included, 8 were prospective studies and 28 were retrospective studies. The year of publication ranged from 1992 to 2015. Study size ranged from 21 to 711 patients. Three studies found that good preoperative Karnofsky Performance Status (KPS ≥ 80%) was a significant predictor of survival. No study reported a significant effect of time-to-surgery following the onset of spinal cord compression symptoms on survival. Three studies reported improvement in neurological function following surgery. The most commonly cited complication was wound infection or dehiscence (22 studies). Eight studies reported that preoperative ambulatory or preoperative motor status was a significant predictor of postoperative ambulatory status. A wide variety of surgical techniques were reported: posterior decompression and stabilization, posterior decompression without stabilization, and posterior decompression with total or subtotal tumor resection. Although a wide range of functional scales were used to assess neurological outcomes, four studies used the American Spinal Injury Association (ASIA) Impairment Scale to assess neurological function. Four studies reported the effects of radiation therapy and local disease control for spinal metastases. Two studies reported that the type of treatment was not significantly associated with the rate of local control. The most commonly reported primary tumor types included lung cancer, prostate cancer, breast cancer, renal cancer, and gastrointestinal cancer. CONCLUSIONS This study reports a systematic review of the literature on decompression surgery for spinal metastases. The results of this study can help educate surgeons on the previously published predictors of outcomes following decompression surgery for metastatic spinal disease. However, the authors also identify significant gaps in the literature and the need for future studies investigating the optimal practice with regard to decompression surgery for spinal metastases.

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Section: Predictors Of Survivalmentioning

confidence: 99%

“…2,3,11,18,36 All 5 studies were retrospective. The most common primary tumor site included renal cancer (4 studies), breast cancer (3 studies), prostate cancer (3 studies), gastrointestinal cancer (3 studies), and lung cancer (2 studies).…”

Section: Primary Tumor Sitementioning

confidence: 99%

Decompression surgery for spinal metastases: a systematic review

Bakar

Tanenbaum

Phan

et al. 2016

FOC

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“…Another two studies (HR = 199.239, 95% CI 2.615–15180.426 and HR = 5.55, 95% CI 2.39–12.89, respectively) were excluded due to severe heterogeneity with other studies according to sensitivity analysis. Finally, 18 studies containing 5468 patients fulfilled the inclusion criteria, and hence were enrolled in the meta‐analysis that consisted of 14 studies with an effect size for HR and four for RR. The schematic representation of the literature search was shown in Fig.…”

Section: Resultsmentioning

confidence: 99%

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

Lun

Chen

Feng

et al. 2020

Orthopaedic Surgery

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Objective: To characterize the visceral metastasis as a predictive tool for the survival of patients with spinal metastases through an exploratory meta-analysis.Methods: Two investigators independently searched PubMed and Embase databases for eligible studies from 2000-2016. The effect estimates for the hazard ratio (HR) or risk ratio (RR) and 95% confidence interval (CI) were collected and pooled with a random-or fixed-effect model.Results: In total, 18 eligible studies were retrieved with 5468 participants from nine countries. The overall pooled effect size for HR and RR was 1.50 and 3.79, respectively, which was proved to be statistically significant. In the subgroup of prostate cancer (PCa) and non-small cell lung cancer (NSCLC), statistical significance and marginal statistical significance was presented for the pooled HR (HR = 1.76, 95% CI 1.35-2.29) and (RR = 1.56, 95% CI 0.99-2.48), respectively. However, in the subgroup of thyroid cancer, breast cancer, and renal cancer, statistical significance was not achieved (HR = 1.17, 95% CI 0.75-1.83, Z = 0.70, P = 0.486). The results did not show any evidence of publication bias. Conclusions:This study demonstrated that visceral metastasis was a significant prognostic factor in patients with spinal metastases as a whole. Interestingly, the onset of visceral metastases differentially impacted the survival in different primary tumors. Therefore, the prognostic value of visceral metastasis might be related to the type of primary tumor.

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“…Another 4 studies by Rades were also excluded that used the same patient cohorts as other studies. Finally, 17 studies containing 3962 participants met the inclusion criteria, of which 14 studies involved comparison between ambulatory and non‐ambulatory groups of patients on the influence of overall survival after treatment and 4 studies reported comparison between Frankel grade C–D and Frankel grade E.…”

Section: Resultsmentioning

confidence: 99%

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

Yang

Han

Wang

et al. 2018

Orthopaedic Surgery

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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.

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Surgery on spinal epidural metastases (SEM) in renal cell carcinoma: a plea for a new paradigm

Cited by 10 publications

References 9 publications

Decompression surgery for spinal metastases: a systematic review

Decompression surgery for spinal metastases: a systematic review

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

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

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