Abstract
ObjectTo identify pre-operative prognostic parameters for survival in patients with spinal epidural neoplastic metastasis when the primary tumour is unknown.MethodsThis study was a retrospective chart review of patients who underwent surgery for spinal epidural neoplastic metastases between February 1997 and January 2011. The inclusion criteria were as follows: known post-operative survival period, a Karnofsky Performance Score equal to or greater than 30 points and a post-operative neoplastic metastasis histological type. The Kaplan-Meier method was used to estimate post-operative survival, and the Log-Rank test was used for statistical inference.ResultsA total of 52 patients who underwent 52 surgical procedures were identified. The mean age at the time of spinal surgery was 53.92 years (std. deviation, 19.09). The median survival after surgery was 70 days (95% CI 49.97–90.02), and post-operative mortality occurred within 6 months in 38 (73.07%) patients. Lung cancer, prostate cancer, myeloma and lymphoma, the 4 most common primary tumour types, affected 32 (61.53%) patients. The three identified prognostic parameters were the following: pre-operative walking incapacity (American Spinal Injury Association, A and B), present in 86.53% of the patients (p-value = 0.107); special care dependency (Karnofsky Performance Score, 10–40 points), present in 90.38% of the patients (p-value = 0.322); and vertebral epidural neoplastic metastases that were in contact with the thecal sac (Weinstein-Boriani-Biagini, sector D), present in 94.23% of the patients (p-value = 0.643). When the three secondary prognostic parameters were combined, the mean post-operative survival was 45 days; when at least one was present, the survival was 82 days (p-value = 0.175).ConclusionsWalking incapacity, special care dependency and contact between the neoplastic metastases and the thecal sac can help determine the ultimate survival of this patient population and, potentially, which patients would benefit from surgery versus palliation alone. A 2- to 3-month post-operative survival period justified surgical treatment.
Highlights
The vertebral column is the most common site of skeletal metastases and is involved in approximately 40% of the patients who die of cancer [1,2,3,4]
Patients of all ages and both genders who met the following criteria were included in the study: a known survival period after surgery, spinal epidural neoplastic metastases, a Karnofsky Performance Score (KPS) [40] equal to or greater than 30 points and neoplastic metastases with a known histological type
Primary versus secondary prognostic parameters When the primary parameter of prognosis is unknown, we propose the use of secondary parameters of prognosis
Summary
The vertebral column is the most common site of skeletal metastases and is involved in approximately 40% of the patients who die of cancer [1,2,3,4]. In patients who harbour spinal epidural neoplastic metastasis, surgery is indicated for the diagnosis of the histological type of the tumour, segmental vertebrae instability and neurological deficit, muscular force motor deficit [1,5,18,22,23]. There are no official government statistics for the prevalence of spinal metastases and unknown primary tumours [37]. Accessible pre-operative secondary prognostic parameters tailored for developing countries is a gap in the literature and could supplement the lack of cancer outcome data, for patients with spinal epidural neoplastic metastases
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