Abstract
ObjectiveTo investigate whether visceral metastases have a significant impact on survival in patients with metastasis‐related spinal cord compression (MSCC), and to determine the difference in prognosis between patients with and without visceral metastases.MethodsThree institutional databases were searched to identify all patients who had undergone spinal surgery for spinal metastases between March 2002 and June 2010. Data on patient characteristics including pre‐ and post‐operative medical conditions, were collected from medical records or by telephone follow‐up. Survival data were obtained either from medical records or by searching a governmental cancer registry.ResultsThe mean age of study patients was 59.6 ± 10.5 years (range, 18–84 years), of whom 102 were male and 67 female. The median and mean postoperative survival times were 7.0 ± 0.5 (95% CI 6.0–8.0) months and 12.6 ± 1.2 (95% CI 10.1–15.0) months, respectively, in all patients, being 5.0 ± 0.5 (95% CI 4.0–6.0) months and 10.8 ± 2.4 (95% CI 6.1–15.5) months, respectively, for patients with visceral metastases and 7.0 ± 0.8 (95% CI 5.4–8.6) months and 13.0 ± 1.4 (95%CI 10.3–15.6) months, respectively, for patients without visceral metastases (P = 0.87). These survival times did not differ significantly between groups. Multivariate Cox proportional hazard regressions showed that visceral metastases had no statistically significant association with survival (P = 0.277), whereas rate of growth of primary tumor (P = 0.003), preoperative Karnofsky performance status (KPS) (P < 0.001), change in KPS (P < 0.001), and Frankel grade (P = 0.091) were independent prognostic factors in the whole cohort (P = 0.005). Changes in KPS (P = 0.001) and major complications (P = 0.003) were significantly associated with survival in patients with visceral metastases, whereas rate of growth of primary tumor (P = 0.016), change in KPS (P = 0.001), and preoperative KPS (P < 0.001) were significantly associated with survival in patients without visceral metastases.ConclusionsVisceral metastases do not appear to predict the prognosis of patients with MSCC; thus, more aggressive surgery should be considered in patients with MSCC who have visceral metastases. Additionally, prognostic factors differ according to visceral metastases status in these patients.
Highlights
Recent treatment survival time in regimens patients have with prolonged median cancer, which has led to a high frequency of metastatic spinal cord compression (MSCC) during the remaining lifetime of these patients
The median and mean postoperative survival times were 7.0 Æ 0.5 (95%confidence intervals (CIs) 6.0–8.0) months and 12.6 Æ 1.2 months, respectively, in the whole cohort, being 5.0 Æ 0.5 (95%CI 4.0–6.0) months and 10.8 Æ 2.4 (95%CI 6.1–15.5) months, respectively, in patients with visceral metastases and 7.0 Æ 0.8 months and 13.0 Æ 1.4 months, respectively, in patients without visceral metastases (P = 0.87) (Fig. 1)
There was a trend toward lower overall survival (OS) rates in patients with visceral metastases compared with those without them; this difference was not significant (HR 1.28, 95% CI 0.82–2.01, P = 0.277)
Summary
Recent treatment survival time in regimens patients have with prolonged median cancer, which has led to a high frequency of metastatic spinal cord compression (MSCC) during the remaining lifetime of these patients. PROGNOSTIC EFFECT OF VISCERAL METASTASIS ON MSCC develop spinal metastases1,2, 20% of whom develop neurological deficits[3–5]. Almost 10% of patients with MSCC choose to undergo surgical decompression with or without stabilization[4,6–8], which can restore neurological function and improve their quality of life. It is not yet clear how to identify the patients who would benefit most from surgical treatment. It is generally accepted that life expectancy drives treatment regimens for spine metastases[9]. Decompressive surgery is generally not considered indicated in patients with life expectancies of less than 3 months[10]
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