The impact of complete surgical resection of spinal metastases on the survival of patients with thyroid cancer

Abstract

Spinal metastases (SMs) from thyroid cancers significantly reduce the quality of life by causing pain and neurological deficits and increase mortality. Complete surgical resection of isolated thyroid SMs is a promising treatment option; however, the postoperative outcome is unknown. This study aimed to compare the postoperative courses of patients undergoing complete resection of thyroid SMs with those of patients undergoing incomplete resection, with a minimum 4‐year follow‐up. We performed a retrospective analysis of 32 patients who underwent tumor excision surgery for thyroid SMs at our medical center during a 28‐year period. Twenty patients underwent complete excision, and 12 underwent incomplete excision. Survival was defined as the time from the first spinal surgery to death or last follow‐up. Kaplan–Meier analysis with the long‐rank test was used to compare the overall survival rates between the groups. For all patients, the overall 5‐ and 10‐year survival rates were 71% and 31%, respectively. The median overall survival time was 6.4 years. The patients undergoing complete excision survived longer than those undergoing incomplete excision (5‐year survival: 84% vs. 50%; 10‐year survival: 52% vs. 8%; P < 0.01). Only one patient undergoing complete excision experienced local tumor recurrence in the operated spine, whereas all long‐term survivors (>18 months after surgery) in the incomplete excision group experienced local tumor recurrence and a consequent deterioration in performance status. Complete surgical resection of thyroid SMs, if achievable, has the potential not only to maintain performance status, but also to prolong survival.

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

“…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.…”

“…The axial pain was the main clinical symptom in seven studies with 2290 patients. Of those,1493 patients in three studies received surgery plus adjuvant therapy, 140 patients in three studies with surgery alone, 43 ones with surgery and other adjuvant therapy. Studies were conducted in different countries: five in the USA, three in Germany, three in China, three in the Netherlands, and one each in Japan, Sweden, Austria, South Korea, and Dutch.…”

“…Only two articles included in the meta‐analysis showed no statistical significance. Kato et al . reported that the presence of lung metastases was not associated with survival because lung metastases respond to radioiodine treatment as compared to the metastases of other organs.…”

Total En Bloc Spondylectomy Combined with the Satellite Rod Technique for Spinal Tumors

“…The 1-, 5-and 10-year survival rates of the primary tumors were 96.3%, 82.2% and 71%, respectively, and the 1-and 5-year survival rates of the metastatic tumors were 80.8% and 56.6%, respectively [6]. Compared with piecemeal or intralesional excisions, TES is currently a more suitable surgical procedure yielding good long-term local control and longer survival rates for patients with spinal tumors and favorable circumstances, according to physicians, surgeons, and patients [5,20,22].…”

“…Currently, it is generally accepted that total en bloc spondylectomy (TES), in combination with multidisciplinary management, is crucial for disease-free survival in patients with primary and metastatic spinal neoplasms [1][2][3]. TES, which was rst described by Tomita et al [4] in 1994, has been proven to decrease the rate of local recurrence and prolong survival via a margin-free resection which can prevent tumor cell contamination in surrounding tissues [5,6]. After en bloc resection of diseased vertebra, the spinal column is completely separated, especially in patients with tumors extending to paraspinal muscles, ribs and other surrounding structures that also need to be removed, making the spine extremely unstable [7].…”