Abstract
ObjectivesTo investigate the association between the number of metastases to the spine and survival in patients with metastatic spinal cord compression (MSCC), as well as the prognosis difference between patients with solitary spinal metastasis (SSM) and multiple spinal metastases (MSM).MethodsThree institutional databases were searched to identify all patients who had undergone spinal surgery for metastatic spinal tumors between March 2002 and June 2010. As well as age and gender, preoperative medical conditions were collected from medical records, including primary tumor, preoperative Frankel score, other bone metastases, preoperative Karnofsky performance status (KPS), number of involved vertebrae, pathological fracture metastasis site, serum albumin, sphincter dysfunction and the time of developing motor deficits before surgery. Survival data were obtained from medical records or via telephone follow‐ups. Univariate and multivariate predictors of overall survival for each group were assessed using the Cox proportional hazards model.ResultsThe median postoperative survival time was 6.0 ± 0.6 months (95% confidence interval [CI] 4.8–7.2) in patients with SSM and 7.0 ± 1.0 months (95% CI 5.1–8.9) in patients with MSM (P = 0.238). The difference in survival was not significant between groups. Furthermore, univariate analysis showed that the number of spinal metastases had no significant association with survival (P = 0.075). Primary tumor (P = 0.004) and preoperative KPS (P < 0.001) were independent prognostic factors in the whole cohort; primary tumor (P = 0.020), time of developing motor deficit (P = 0.041) and preoperative KPS (P = 0.038) were independent prognostic factors in patients with SSM; while preoperative KPS (P = 0.001) and serum album level (P < 0.001) were independent prognostic factors in patients with MSM.ConclusionThe number of spinal metastases has not proven to be useful in predicting the prognosis for patients with MSCC. Consequently, more aggressive operations should be considered for patients with multiple spinal metastases.
Highlights
Taking into consideration advanced treatment technologies and extended survival time, the aim of surgical treatment for patients with metastatic spinal cord compression (MSCC) should no longer be only about relieving pain and restoring function and about achieving better local control and reducing reoperation rates over the remaining lifetime
There is still considerable controversy regarding the association between the number of metastases to the spine and survival prognosis[8,9,10,11,12,13,14,15,16]
Tomita et al.[8], Tokuhashi et al.[9,11] and Sioutos et al.[12] reported that patients with multiple spinal metastases had a poor prognosis compared to those with a solitary spinal lesion. They considered the number of metastatic tumors as one of the prognostic factors in their scoring systems; Bauer[13], modified Bauer[14], Van der Linden et al.[15] and Rades et al.[16] have omitted the number of spinal metastases from their scoring systems
Summary
Taking into consideration advanced treatment technologies and extended survival time, the aim of surgical treatment for patients with metastatic spinal cord compression (MSCC) should no longer be only about relieving pain and restoring function and about achieving better local control and reducing reoperation rates over the remaining lifetime. Tomita et al.[8], Tokuhashi et al.[9,11] and Sioutos et al.[12] reported that patients with multiple spinal metastases had a poor prognosis compared to those with a solitary spinal lesion. They considered the number of metastatic tumors as one of the prognostic factors in their scoring systems; Bauer[13], modified Bauer[14], Van der Linden et al.[15] and Rades et al.[16] have omitted the number of spinal metastases from their scoring systems
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