Article Figures & Data
Figures
- Figure 1
Kaplan–Meier plot of overall survival.
- Figure 2
Cox regression and forest plot of therapy type and overall survival controlling for age, race, sex, insurance, and preoperative targeted systemic therapy.
- Figure 3
Kaplan–Meier plot of local recurrence.
- Figure 4
(A) 45-year-old man with renal cell carcinoma presented with worsening left upper extremity weakness and back pain. The patient had evident T4 and T7 lesions compressing the spinal cord on preoperative sagittal, contrasted T1-weighted magnetic resonance imaging (MRI) (A), axial T2-weighted MRI at T4 (B), and axial T2-weighted MRI at T7 (C). Subsequently, the patient underwent posterior spinal fusion from T2 to T9, multiple posterior column osteotomies, and laminectomy with bilateral transpedicular decompression at T4 and T7 with tumor debulking, as shown on lateral and posteroanterior x-rays (D and E).
Tables
- Table 1
Demographics and preoperative data of patients undergoing spine surgery for metastatic renal cell carcinoma according to postoperative treatment received.
Characteristic All (N = 49) Radiotherapy (n = 4) Targeted Systemic Therapy (n = 19) Dual Therapy
(n = 12)Neither Therapy (n = 14) P Age, y, n (%) 59.5 ± 10.0 54.6 ± 12.7 59.2 ± 11.1 57.9 ± 7.1 62.7 ± 10.1 0.401 Gender, n (%) 0.337 Women 16 (32.7%) 3 (75.0%) 5 (26.3%) 4 (33.3%) 4 (28.6%) Men 33 (67.3%) 1 (25.0%) 14 (73.7%) 8 (66.7%) 10 (71.4%) Race, n (%) 0.229 Non-White 4 (8.2%) 0 (0.0%) 0 (0.0%) 2 (16.7%) 2 (14.3%) White 45 (91.8%) 4 (100.0%) 19 (100.0%) 10 (83.3%) 12 (85.7%) Insurance, n (%) 0.536 Private 15 (30.6%) 0 (0.0%) 6 (31.6%) 6 (50.0%) 3 (21.4%) Public 18 (36.7%) 3 (75.0%) 7 (36.8%) 3 (25.0%) 5 (35.7%) Uninsured 16 (32.7%) 1 (25.0%) 6 (31.6%) 3 (25.0%) 6 (42.9%) Body mass index (kg/m2), mean ± SD 29.5 ± 9.5 27.1 ± 9.2 28.5 ± 6.3 29.8 ± 11.1 31.4 ± 12.3 0.834 Symptom duration, mo, mean ± SD 1.8 ± 1.5 3.0 ± 2.1 1.6 ± 1.3 1.5 ± 1.6 1.9 ± 1.4 0.477 Comorbidities, n (%) 0.626 0 20 (40.8%) 1 (25.0%) 8 (42.1%) 7 (58.3%) 4 (28.6%) 1 18 (36.7%) 1 (25.0%) 7 (36.8%) 4 (33.3%) 6 (42.9%) 2+ 11 (22.4%) 2 (50.0%) 4 (21.1%) 1 (8.3%) 4 (28.6%) Smoking, n (%) 0.097 No 26 (53.1%) 1 (25.0%) 13 (68.4%) 6 (50.0%) 6 (42.9%) Current 15 (30.6%) 2 (50.0%) 6 (31.6%) 4 (33.3%) 3 (21.4%) Prior 8 (16.3%) 1 (25.0%) 0 (0.0%) 2 (16.7%) 5 (35.7%) Other organ metastasis, n (%) 32 (65.3%) 1 (25.0%) 16 (84.2%) 7 (58.3%) 8 (57.1%) 0.083 Last follow-up, d, mean ± SD 712.9 ± 720.7 1034.0 ± 797.4 468.2 ± 305.8 1334.7 ± 1044.3 420.4 ± 387.9 0.018 Preoperative targeted systemic therapy, n (%) <0.001 Monoclonal antibodies 3 (6.1%) 0 (0.0%) 2 (10.5%) 1 (8.3%) 0 (0.0%) Tyrosine kinase 9 (18.4%) 1 (25.0%) 7 (36.8%) 1 (8.3%) 0 (0.0%) Combination 3 (6.1%) 0 (0.0%) 2 (10.5%) 1 (8.3%) 0 (0.0%) Neither 34 (69.4%) 3 (75.0%) 8 (42.1%) 9 (75.0%) 14 (100.0%) Postoperative targeted systemic therapy, n (%) <0.001 Monoclonal antibodies 4 (8.2%) 0 (0.0%) 3 (15.8%) 1 (8.3%) 0 (0.0%) Tyrosine kinase 20 (40.8%) 0 (0.0%) 12 (63.2%) 8 (66.7%) 0 (0.0%) Combination 7 (14.3%) 0 (0.0%) 4 (21.1%) 3 (25.0%) 0 (0.0%) Neither 18 (36.7%) 4 (100.0%) 0 (0.0%) 0 (0.0%) 14 (100.0%) Note: Boldface indicates statistically significant findings.
- Table 2
Perioperative and intraoperative variables of patients undergoing spine surgery for metastatic renal cell carcinoma according to postoperative treatment received.
Variable All (N = 49) Radiotherapy (n = 4) Targeted Systemic Therapy (n = 19) Dual Therapy (n = 12) Neither Therapy (n = 14) P Perioperative Variables Mechanical pain, n (%) 27 (55.1%) 2 (50.0%) 8 (42.1%) 7 (58.3%) 10 (71.4%) 0.426 Biological pain, n (%) 25 (51.0%) 2 (50.0%) 12 (63.2%) 7 (58.3%) 4 (28.6%) 0.255 Neurological pain, n (%) 25 (51.0%) 0 (0.0%) 11 (57.9%) 6 (50.0%) 8 (57.1%) 0.226 Sensory deficit, n (%) 18 (36.7%) 0 (0.0%) 9 (47.4%) 3 (25.0%) 6 (42.9%) 0.266 Motor deficit, n (%) 21 (42.9%) 3 (75.0%) 10 (52.6%) 5 (41.7%) 3 (21.4%) 0.164 Preoperative Karnofsky Performance Score, mean ± SD 70.2 ± 15.7 73.8 ± 17.0 64.2 ± 19.2 75.0 ± 12.4 73.2 ± 10.7 0.372 Tumor Size (levels), mean ± SD 1.7 ± 1.4 2.2 ± 1.9 1.5 ± 0.8 1.2 ± 0.4 2.2 ± 2.2 0.413 Oligometastatic, n (%) 0.157 0 34 (69.4%) 4 (100.0%) 10 (52.6%) 8 (66.7%) 12 (85.7%) <5 13 (26.5%) 0 (0.0%) 8 (42.1%) 4 (33.3%) 1 (7.1%) 5+ 2 (4.1%) 0 (0.0%) 1 (5.3%) 0 (0.0%) 1 (7.1%) Bilsky score, n (%) 0.034 0 1 (2.0%) 0 (0.0%) 0 (0.0%) 1 (8.3%) 0 (0.0%) 1a 4 (8.2%) 1 (25.0%) 0 (0.0%) 2 (16.7%) 1 (7.1%) 1b 4 (8.2%) 1 (25.0%) 0 (0.0%) 3 (25.0%) 0 (0.0%) 2 14 (28.6%) 0 (0.0%) 5 (26.3%) 3 (25.0%) 6 (42.9%) 3 24 (49.0%) 2 (50.0%) 13 (68.4%) 3 (25.0%) 6 (42.9%) Preoperative embolization, n (%) 23 (47.9%) 3 (75.0%) 8 (42.1%) 7 (58.3%) 5 (38.5%) 0.490 Preoperative radiotherapy, n (%) 4 (8.2%) 0 (0.0%) 4 (21.1%) 0 (0.0%) 0 (0.0%) 0.116 Intraoperative Variables Total decompressed levels, mean ± SD 2.9 ± 1.3 3.2 ± 1.0 3.3 ± 1.5 2.8 ± 1.5 2.5 ± 1.1 0.341 Total instrumented levels, mean ± SD 5.0 ± 2.1 5.2 ± 1.7 4.8 ± 1.8 4.5 ± 2.2 5.8 ± 2.4 0.389 Transpedicular approach, n (%) 23 (46.9%) 2 (50.0%) 9 (47.4%) 6 (50.0%) 6 (42.9%) >0.999 Costotransversectomy, n (%) 10 (20.4%) 1 (25.0%) 4 (21.1%) 4 (33.3%) 1 (7.1%) 0.365 Operative time, min, mean ± SD 325.1 ± 127.1 320.0 ± 165.8 361.1 ± 131.6 342.7 ± 113.5 262.9 ± 109.7 0.051 Estimated blood loss, mL, mean ± SD 1408.8 ± 1239.9 868.8 ± 675.0 1462.1 ± 1104.4 1375.0 ± 1126.4 1519.6 ± 1643.4 0.799 Intraoperative monitor change, n (%) 2 (4.1%) 0 (0.0%) 0 (0.0%) 1 (8.3%) 1 (7.1%) 0.435 Length of stay, d, mean ± SD 6.7 ± 6.0 13.8 ± 16.5 5.5 ± 3.3 6.6 ± 5.3 6.5 ± 3.7 0.726 Note: Boldface indicates statistically significant findings.
- Table 3
Outcomes of patients by postoperative therapy for metastatic renal cell carcinoma.
Patient Outcome All (N = 49) Radiotherapy (n = 4) Targeted Systemic Therapy (N = 19) Dual Therapy(n = 12) Neither Therapy (N = 14) P Any complications, n (%) 12 (24.5%) 1 (25.0%) 6 (31.6%) 4 (33.3%) 1 (7.1%) 0.272 Readmission, n (%) 11 (22.4%) 1 (25.0%) 5 (26.3%) 3 (25.0%) 2 (14.3%) 0.884 Reoperation, n (%) 5 (10.2%) 1 (25.0%) 2 (10.5%) 1 (8.3%) 1 (7.1%) 0.734 Postoperative KPS, mean ± SD 79.4 ± 12.5 83.3 ± 11.5 77.1 ± 13.1 85.5 ± 8.2 75.0 ± 14.6 0.252 Last KPS, mean ± SD 63.2 ± 20.1 70.0 ± 10.0 58.3 ± 17.9 63.5 ± 27.3 71.7 ± 14.7 0.466 Postoperative MMS, mean ± SD 1.5 ± 0.9 1.3 ± 0.6 1.6 ± 1.1 1.2 ± 0.4 1.9 ± 1.0 0.346 Last MMS, mean ± SD 2.0 ± 1.3 2.0 ± 1.0 1.9 ± 1.3 2.2 ± 1.5 1.8 ± 1.0 0.980 LR, n (%) 7 (14.3%) 0 (0.0%) 1 (5.3%) 5 (41.7%) 1 (7.1%) 0.033 Time to LR, mean ± SD 477.3 ± 453.6 - 130.0 457.2 ± 477.4 925.0 0.424 Death, n (%) 39 (81.2%) 3 (75.0%) 16 (88.9%) 10 (83.3%) 11 (78.3%) 0.627 Time to death, mean ± SD 723.0 ± 752.3 940.0 ± 949.1 495.7 ± 315.8 1285.5 ± 1080.6 403.1 ± 425.0 0.066 Abbreviations: KPS, Karnofsky Performance Score; LR, local recurrence; MMS, Modified McCormick Scale.
Note: Boldface indicates statistically significant findings.
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