Abstract
BACKGROUND CONTEXT Spinal metastases are a common complication to several types of cancer. Estimated survival time is a key for treatment decision and several predictive scoring systems lag behind oncological advancements, as they often are based on old case series. Survival data on recently treated patients is needed to reflect the effects of modern cancer treatments. PURPOSE To evaluate indications for surgery, survival and cause of death after surgery for spinal metastatic disease. STUDY DESIGN/SETTING A retrospective cohort study with patients undergoing surgery due to spinal metastatic disease in Sweden 2006-2016. PATIENT SAMPLE A total of 1,820 patients (67% males) 18 years or older with a Swedish Personal ID number and registered in Swespine, the Swedish national spine surgery register. OUTCOME MEASURES Indications for surgery, survival after surgery and cause of death. METHODS A search was made in Swespine for adult patients undergoing surgery due to spinal metastatic disease 2006-2016 in Sweden. A total of 1,820 patients (age 18-95, mean age 67 years, 67% males) were included. The records found were matched with the Swedish Register for Cause of Death (CoD), containing survival data and cause of death. The results were stratified according to tumor type. RESULTS Neurologic deficit was the most common indication for surgery, as reported by the surgeon. The median estimated survival after surgery was survival 6.2 months (95% CI 5.6-6.8) and the mean estimated survival time was 12.2 months (95% CI 11.4.13.1). As of January 31, 2016, 531 of the patients were alive and 1,289 were dead. A neoplasm was stated as main cause of death in 97% of the cases. CONCLUSIONS This is to the best of our knowledge the largest single-country cohort with surgically treated spinal metastatic disease in recent time. With both median and mean survival time well above the commonly used score estimates, our results imply that surgery may be reasonable in even more cases. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.
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