Survival and clinical outcomes in patients with metastatic epidural spinal cord compression after spinal surgery: a prospective, multicenter, observational cohort study.

Anick Nater,Michael G Fehlings

doi:10.1186/s40880-016-0091-5

Abstract

BackgroundHigh quality studies have been challenging to undertake in patients with metastatic epidural spinal cord compression. Nonetheless, in the article “Survival and Clinical Outcomes in Surgically Treated Patients With Metastatic Epidural Spinal Cord Compression: Results of the Prospective Multicenter AOSpine Study” recently published in the Journal of Clinical Oncology, our team provided convincing evidence that spinal surgery improves overall quality of life in patients with this potentially devastating complication of cancer. Considering that metastatic spinal lesions treated with surgery have the highest mean cost among all oncological musculo-skeletal issues, it is essential to provide high quality data to optimize the therapeutic approaches and cost-effective use of health care resources.Main bodyAlthough the AOSpine Study provided high quality prospective data, it was primarily limited by the lack of non-operative controls and the relatively small sample size. Given the dearth of medical equipoise and the fundamental difference between patients deemed to be adequate surgical candidates and those who are not amenable to operative intervention, conducting a randomized controlled trial in this patient population was not felt to be ethically or medically feasible. Consequently, the optimal option to overcome limitations of both the lack of controls and the relatively small sample size is through collection of large prospective datasets through rigorously developed and maintained registries.ConclusionsWith the alarming increase in the incidence of cancer in China and China’s parallel growing cancer control efforts, China would offer a fantastic platform to set up a national metastatic spinal lesion registry. Such registry would not only enhance metastatic epidural spinal cord compression translational research but also optimize patient care.

Highlights

In our recent manuscript published in Journal of Clinical Oncology, we reported the results of the AOSpine North America metastatic epidural spinal cord compression (MESCC) study, a prospective, multicenter, observational, cohort study conducted over a 5-year period in ten North American sites for which a total of 142 surgically treated patients with a single symptomatic MESCC lesion were followed postoperatively for at least 12 months [12]
Considering that of all skeletal-related events occurring in cancer patients, MESCC treated with surgery is currently associated with the highest mean costs [10, 11], evaluating the survival and clinical outcomes in MESCC patients who undergo surgical treatment is a topic of great interest for humanistic and clinical reasons and for socio-economic reasons
Main text In our recent manuscript published in Journal of Clinical Oncology, we reported the results of the AOSpine North America MESCC study, a prospective, multicenter, observational, cohort study conducted over a 5-year period in ten North American sites for which a total of 142 surgically treated patients with a single symptomatic MESCC lesion were followed postoperatively for at least 12 months [12]

Summary

Conclusions

The AOSpine MESCC study provided high quality data suggesting that the majority of MESCC patients suffering from a single symptomatic lesion would have their overall HRQoL improved postoperatively. To build on this work, we would strongly advocate for the development of high quality prospective registries for metastatic spinal cancer Such registries, including those undertaken by the Global Spine Tumor Study Group (GSTSG) [20] and the AOSpine Knowledge Forum-Oncology [21], would include questions such as: what are the modifiable and nonmodifiable preoperative predictive factors of survival, neurological, functional, and HRQoL outcomes, and of complications in surgical MESCC patients or which outcome measure(s) are best suited for these patients. Both authors read and approved the final manuscript. Author details 1 Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, ON, Canada. Competing interests The authors declare that they have no competing interests

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