Prognostic factors of moter function after surgery for patients with metastatic spinal cord compression: a multicenter retrospective cohort stduy

Abstract

Objective To identify prognostic factors ofmotorfunctionafter surgery of metastatic spinal cord compression (MSCC). Methods The clinical data of 681 patients with spinal metastases from January 2008 to December 2017 were retrospectively analyzed.According to inclusion and exclusion criteria, a total of 206 patients with spinal metastatic were included. Postoperative neurological function was assessed using Frankel classification.The influence of age, gender, preoperative status, number of spine metastases, location of spinal metastases, visceral metastases, bone metastases, primary tumor type,interval from symptom to surgery,time of developing motor deficits,interval from primary tumor diagnosis to MSCC,preoperativethe Eastern Cooperative Oncology Group performance status (ECOG-PS), Karnofsky Performance score (KPS) and surgical procedures on postoperative function outcomes were explored. Results 140 (68.0%) patients were able to walk postoperatively compared with 88 (42.7%) patients preoperatively. Moreover, in 89.8% of all patients, 79 ambulatory patients maintained ambulation after treatment. The univariate analysis according to Ordered-logit model showed thatnumber of spine metastases, location of spinal metastases, preoperative ECOG-PS, preoperative KPS, interval from symptom to surgery and time of developing motor deficits were related with post-treatment motor functions. The multivariable analysis showed that number of spine metastases (OR=2.03; 95%CI: 1.12-3.33; P=0.04), preoperative ECOG-PS (OR=4.84; 95%CI: 2.42-8.15; P=0.038), interval from symptom to surgery (OR=3.78;95%CI: 3.12-9.15;P=0.024), time of developing motor deficits(OR=2.75;95%CI:1.22-3.89;P=0.01) were independent prognostic factors for function outcomes. Conclusion 1-2 levels of metastasis,Interval from symptom to treatment ≥ 48 h, time of developing motor deficits ≥7 d, and ECOG-PS 1-2 can be considered as the most significant positive prognosticfactors for post-treatment ambulatory status. Spinal metastasis should have a higher priority, and immediate intervention should be started before the development of irreversible neurologic deficits. Increasing awareness of early symptoms and earlier screeningwith regular outpatient review might make a difference for patients with MSCC. Consequently, the identified prognostic factors can be considered as apreoperative assessment tool to predict the neurologic outcomeand guide clinical treatment for individual patients with MSCC. Key words: Spinal cord compression; Locomotion; Prognosis