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

Mingxing Lei,Shubin Liu,Yaosheng Liu,Liang Yan,Shaoxing Yang,Chuanghao Tang

doi:10.1007/s00586-015-4290-6

Mingxing Lei, Shubin Liu + Show 4 more

Open Access

https://doi.org/10.1007/s00586-015-4290-6

Copy DOI

Abstract

This study aims to create and validate a score for survival and functional outcome of lung cancer patients with metastatic spinal cord compression (MSCC) after posterior decompressive surgery. The entire cohort of 73 consecutive patients was randomly assigned to a test group (N=37) and a validation group (N=36). In the test group, we retrospectively analyzed 10 preoperative characteristics. Characteristics significantly associated with survival on multivariate analysis were included in the score. Patients in the validation group were used to confirm whether the score was reproducible. Postoperative functional outcome was analyzed both in the test and validation groups. On multivariate analysis, preoperative ambulatory status (P=0.0017), visceral metastases (P=0.0002), and time developing motor deficits (P=0.0004) had significant impact on survival and were included in the scoring system. According to the prognostic scores, which ranged from 0 to 6 points, two risk groups were designed: 0-2 and 3-6 points and the median survival was 2.6months (95% CI, 1.0-3.8months) and 10.7months (95% CI, 7.1-13.7months), respectively (P<0.0001). In the validation group, the corresponding median survival was 2.7months (95% CI, 1.6-5.5months) and 10.8months (5.8-13.6months), respectively (P<0.0001). In addition, the functional outcome was worse in patients with 0-2 points than in patients with 3-6 points both in the test (P=0.0023) and validation groups (P=0.0298). Patients with scores of 0-2 points, who have short survival time (life expectancyless than 3months) and poor functional outcome, appear best treated with radiotherapy or best supportive care alone. Surgery may be no longer in consideration in most of the patients in this group. Patients with score of 3-6 points should be surgical candidates, because survival prognosis (life expectancy more than 10months) and functional outcome are favorable after surgery.

Highlights

28 % of the patients with lung cancer are estimated to develop metastatic spinal cord compression (MSCC) during their disease course [1]
Purpose This study aims to create and validate a score for survival and functional outcome of lung cancer patients with metastatic spinal cord compression (MSCC) after posterior decompressive surgery
Individual strategies are important for patients with MSCC, and patients with very short survival time and poor functional outcome should not be the candidates for decompressive surgery

Summary

Introduction

28 % of the patients with lung cancer are estimated to develop metastatic spinal cord compression (MSCC) during their disease course [1]. The most appropriate treatment for MSCC is still debated. A phase III trial (N = 101) strongly suggested that direct decompressive surgery following postoperative radiotherapy was superior to treatment with radiotherapy alone for MSCC in 2005 [2]. Rades et al [3] proposed the opposite result in 2010, the outcome of radiotherapy alone was not significantly inferior to those of surgery plus radiotherapy. Maranzano et al [4] stated that the choice of radiotherapy alone or surgery in MSCC depended on accurate patient selection. Only a few studies addressed surgical treatment of MSCC in lung cancer [5,6,7].

Objectives

Methods

Results

Conclusion