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Prognostic factors in a series of 504 breast cancer patients with metastatic spinal cord compression

Prognosefaktoren in einer Serie von 504 Brustkrebspatientinnen mit metastatisch bedingter Rückenmarkskompression

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Abstract

Background

This study was performed to identify new significant prognostic factors in breast cancer patients irradiated for metastatic spinal cord compression (MSCC).

Patients and methods

The data of 504 patients with breast cancer patients with MSCC were retrospectively analyzed with respect to posttreatment motor function, local control of MSCC, and survival. The investigated potential prognostic factors included age, Eastern Cooperative Oncology Group (ECOG) performance score, number of involved vertebrae, other bone metastases, visceral metastases, pretreatment ambulatory status, interval from cancer diagnosis to radiotherapy of MSCC, time developing motor deficits before radiotherapy, and the radiation schedule.

Results

On multivariate analysis, better functional outcome was associated with ambulatory status prior to RT (estimate − 1.29, p < 0.001), no visceral metastases (estimate − 0.52, p = 0.020), and slower development of motor deficits (estimate + 2.47, p < 0.001). Improved local control was significantly associated with no other bone metastases (risk ratio (RR) 4.33, 95% confidence interval (CI) 1.36–14.02, p = 0.013) and no visceral metastases (RR 3.02, 95% CI 1.42–6.40, p = 0.005). Improved survival was significantly associated with involvement of only 1–2 vertebrae (RR 1.27, 95% CI 1.01–1.60, p = 0.044), ambulatory status before radiotherapy (RR 1.75, 95% CI 1.23–2.50, p = 0.002), no other bone metastases (RR 1.93, 95% CI 1.18–3.13, p = 0.009), no visceral metastases (RR 7.60, 95% CI 5.39–10.84, p < 0.001), and time developing motor deficits before radiotherapy (RR 1.55, 95% CI 1.30–1.86, p < 0.001).

Conclusion

Several new independent prognostic factors were identified for treatment outcomes. These prognostic factors should be considered in future trials and may be used to develop prognostic scores for breast cancer patients with MSCC.

Zusammenfassung

Hintergrund

Ziel dieser Studie war es, neue Prognosefaktoren bei Brustkrebspatientinnen, die aufgrund einer metastatisch bedingten Rückenmarkskompression (MSCC) bestrahlt wurden, zu identifizieren.

Patienten und Methoden

Die Daten von 504 Brustkrebspatientinnen mit einer MSCC wurden retrospektiv im Hinblick auf die motorische Funktion nach Therapie, die lokale Kontrolle der MSCC und das Gesamtüberleben ausgewertet. Es wurden folgende mögliche Prognosefaktoren untersucht: Alter, Allgemeinzustand („performance score“ der ECOG, Eastern Cooperative Oncology Group), Anzahl befallener Wirbelkörper, Vorhandensein anderer Knochenmetastasen, Vorhandensein von Organmetastasen, Gehfähigkeit vor Therapie, Intervall von der Diagnose der Tumorerkrankung bis zur Strahlentherapie der MSCC, Entwicklungszeit motorischer Defizite vor Strahlentherapie sowie das Strahlentherapieregime.

Ergebnisse

In der Multivarianzanalyse war eine bessere motorische Funktion nach Therapie signifikant mit der Gehfähigkeit vor Strahlentherapie (estimate: − 1,29; p < 0,001), dem Nicht-Vorhandensein von Organmetastasen (estimate: − 0,52; p = 0,020) und einer langsameren Entwicklung motorischer Defizite (estimate: + 2,47; p < 0,001) assoziiert. Eine bessere lokale Kontrolle war signifikant mit dem Nicht-Vorhandensein anderer Knochenmetastasen (Risk Ratio [RR] 4,33; 95% confidence interval [CI] 1,36–14,02; p = 0,013) und dem Nicht-Vorhandensein von Organmetastasen (RR 3,02; 95% CI 1,42–6,40; p = 0,005) assoziiert. Ein besseres Gesamtüberleben war signifikant mit einem Befall von nur 1–2 Wirbelkörpern (RR 1,27; 95% CI 1,01–1,60; p = 0,044), Gehfähigkeit vor Strahlentherapie (RR 1,75; 95% CI 1,23–2,50; p = 0,002), dem Nicht-Vorhandensein anderer Knochenmetastasen (RR 1,93; 95% CI 1,18–3,13; p = 0,009), dem Nicht-Vorhandensein von Organmetastasen (RR 7,60; 95% CI 5,39–10,84; p < 0,001) und einer langsameren Entwicklung motorischer Defizite vor Strahlentherapie (RR 1,55; 95% CI 1,30–1,86; p < 0,001) assoziiert.

Schlussfolgerung

Es wurden verschiedene neue unabhängige Prognosefaktoren identifiziert. Diese Prognosefaktoren sollten in zukünftigen Studien berücksichtigt werden und können bei der Entwicklung von Prognose-Scores für Brustkrebspatientinnen mit MSCC hilfreich sein.

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Conflict of interest

The corresponding author states the following: speaker’s honoraria were received from Amgen, Novartis Oncology, MerckSerono, and AstraZeneca. Travel grants were received from MerckSerono, and research funds were provided by Novartis Oncology and MerckSerono. Relations with MerckSerono and AstraZeneca were not related to the topic of this paper.

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Authors and Affiliations

  1. Department of Radiation Oncology, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lubeck, Germany

    D. Rades MD & S. Douglas

  2. Department of Radiation Oncology, Dr. Bernard Verbeeten Institute, Tilburg, The Netherlands

    T. Veninga

  3. Department of Radiotherapy, Academic Medical Center, Amsterdam, The Netherlands

    L.J.A. Stalpers

  4. Department of Radiation Oncology, University Hospital Hamburg-Eppendorf, Hamburg, Germany

    A. Bajrovic

  5. Department of Radiation Oncology, Saad Specialist Hospital Al-Khobar, Al-Khobar, Saudi-Arabia

    V. Rudat

  6. Department of Radiation Oncology, Mayo Clinic Scottsdale, Scottsdale, AZ, USA

    S.E. Schild

Authors
  1. D. Rades MD
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  2. S. Douglas
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  3. T. Veninga
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  4. L.J.A. Stalpers
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  5. A. Bajrovic
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  6. V. Rudat
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  7. S.E. Schild
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Correspondence to D. Rades MD.

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Rades, D., Douglas, S., Veninga, T. et al. Prognostic factors in a series of 504 breast cancer patients with metastatic spinal cord compression. Strahlenther Onkol 188, 340–345 (2012). https://doi.org/10.1007/s00066-011-0061-4

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  • DOI: https://doi.org/10.1007/s00066-011-0061-4

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