Abstract
Purpose
Metastatic spinal cord compression (MSCC) incidences are increasing. Our objective was to identify predictive factors involved in long-term survival after use of a surgical approach.
Methods
We retrospectively analyzed all patients referred to our institution for MSCC who underwent surgery (N = 138). We identified patients with an overall survival (OS) rate greater than 2 years, compared their characteristics to the remaining patients, and performed recursive partitioning analysis (RPA).
Results
Median OS was 7.8 months (95 % confidence interval 4.4–11.2). Thirty-nine patients presented with OS ≥2 years. A comparative analysis found significant differences concerning the delay (first symptom–surgery, p < 0.001), number of systemic (p = 0.001) or bone metastases (p = 0.013), Karnofsky performance status (KPS) (p = 0.006), Frankel (p = 0.025), ASA scores (p < 0.001), weight loss (p = 0.003), hyperalgia (p = 0.002), chemotherapy use (p = 0.034), and primary tumor (p < 0.001). RPA classification identified six prognostic classes based on the ASA score, primary type, KPS, and systemic metastases.
Conclusion
Long-term metastatic cancer survivor patients are an increasing population with specific characteristics.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Conway R, Graham J, Kidd J et al (2007) What happens to people after malignant cord compression? Survival, function, quality of life, emotional well-being and place of care 1 month after diagnosis. Clin Oncol R Coll Radiol G B 19:56–62
Loblaw DA, Perry J, Chambers A, Laperriere NJ (2005) Systematic review of the diagnosis and management of malignant extradural spinal cord compression: the Cancer Care Ontario Practice Guidelines Initiative’s Neuro-Oncology Disease Site Group. J Clin Oncol Off J Am Soc Clin Oncol 23:2028–2037. doi:10.1200/JCO.2005.00.067
Klimo P Jr, Thompson CJ, Kestle JRW, Schmidt MH (2005) A meta-analysis of surgery versus conventional radiotherapy for the treatment of metastatic spinal epidural disease. Neuro-Oncol 7:64–76. doi:10.1215/S1152851704000262
Maranzano E, Latini P (1995) Effectiveness of radiation therapy without surgery in metastatic spinal cord compression: final results from a prospective trial. Int J Radiat Oncol Biol Phys 32:959–967
Morgen SS, Lund-Andersen C, Larsen CF et al (2013) Prognosis in patients with symptomatic metastatic spinal cord compression: survival in different cancer diagnosis in a cohort of 2,321 patients. Spine 38:1362–1367. doi:10.1097/BRS.0b013e318294835b
Park JH, Jeon SR (2013) Pre- and postoperative lower extremity motor power and ambulatory status of patients with spinal cord compression due to a metastatic spinal tumor. Spine 38:E798–E802. doi:10.1097/BRS.0b013e3182927559
Patchell RA, Tibbs PA, Regine WF et al (2005) Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet 366:643–648. doi:10.1016/S0140-6736(05)66954-1
Tokuhashi Y, Matsuzaki H, Oda H et al (2005) A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. Spine 30:2186–2191
Tomita K, Kawahara N, Kobayashi T et al (2001) Surgical strategy for spinal metastases. Spine 26:298–306
Pointillart V, Vital J-M, Salmi R et al (2011) Survival prognostic factors and clinical outcomes in patients with spinal metastases. J Cancer Res Clin Oncol 137:849–856. doi:10.1007/s00432-010-0946-0
Tabouret E, Cauvin C, Fuentes S et al (2013) Reassessment of scoring systems and prognostic factors for metastatic spinal cord compression. Spine J Off J North Am Spine Soc. doi:10.1016/j.spinee.2013.06.036
Rades D, Veninga T, Bajrovic A et al (2013) A validated scoring system to identify long-term survivors after radiotherapy for metastatic spinal cord compression. Strahlenther Onkol Organ Dtsch Röntgenges Al 189:462–466. doi:10.1007/s00066-013-0342-1
Motzer RJ, Hutson TE, Tomczak P et al (2007) Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med 356:115–124. doi:10.1056/NEJMoa065044
Sandler A, Gray R, Perry MC et al (2006) Paclitaxel-carboplatin alone or with bevacizumab for non-small-cell lung cancer. N Engl J Med 355:2542–2550. doi:10.1056/NEJMoa061884
Rades D, Hueppe M, Schild SE (2013) A score to identify patients with metastatic spinal cord compression who may be candidates for best supportive care. Cancer 119:897–903. doi:10.1002/cncr.27849
Tokuhashi Y, Ajiro Y, Umezawa N (2009) Outcome of treatment for spinal metastases using scoring system for preoperative evaluation of prognosis. Spine 34:69–73. doi:10.1097/BRS.0b013e3181913f19
Quraishi NA, Manoharan SR, Arealis G et al (2013) Accuracy of the revised Tokuhashi score in predicting survival in patients with metastatic spinal cord compression (MSCC). Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 22(Suppl 1):S21–S26. doi:10.1007/s00586-012-2649-5
Furlan JC, Chan KK-W, Sandoval GA et al (2012) The combined use of surgery and radiotherapy to treat patients with epidural cord compression due to metastatic disease: a cost-utility analysis. Neuro-Oncol 14:631–640. doi:10.1093/neuonc/nos062
Conflict of interest
The authors declare no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
586_2014_3676_MOESM3_ESM.tif
Recursive partitioning analysis (RPA) identified three prognostic classes of patients (overall survival in months and 95 % confidence interval). (TIFF 198 kb)
Rights and permissions
About this article
Cite this article
Tabouret, E., Gravis, G., Cauvin, C. et al. Long-term survivors after surgical management of metastatic spinal cord compression. Eur Spine J 24, 209–215 (2015). https://doi.org/10.1007/s00586-014-3676-1
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-014-3676-1