Abstract
Purpose
In patients with metastatic disease to the spine, patient selection for surgery and the extent of surgery to perform thereafter remains controversial, with the patient’s survival prognosis the most important consideration. For this reason, we conducted a prospective study investigating prognostic factors and clinical outcomes in a consecutive series of patients with vertebral metastases.
Methods
A total of 142 consecutive patients with vertebral metastases referred to us for consideration of surgery were prospectively enrolled into this study. Of these, 118 patients subsequently underwent palliative surgery for intractable pain or radiculopathy, bony instability or spinal cord compression. Patients were followed up for 12 months or until death. A multivariate analysis of the patients was conducted using the Cox proportional hazards model. The survival predictive accuracy of the Tokuhashi score was also investigated. For the patients who underwent surgery, pre- and post-operative outcomes were assessed on pain, neurological deficit, function and overall quality of life.
Results
The overall 12-month mortality rate was 50.7% and the median survival was 5 months. Multivariate analysis showed that independent prognostic factors for survival after spinal metastases include primary tumour type, Karnofsky functional status, ASA score and pain. Neither the original nor revised Tokuhashi scores were reliable in predicting survival in our European population. In the patients who underwent operative intervention, there was an immediate and prolonged improvement in pain, neurological deficit, function and quality of life in the majority of cases.
Conclusions
The potential for rapid and maintained improvement in clinical outcome and quality of life should be considered when selecting patients with metastatic disease to the spine for surgery rather than basing decisions solely on survival prognostic factors comprising current scoring systems.
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References
Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC et al (1993) The European organization for research and treatment of cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376
Bartels RH, Feuth T, van der Maazen R, Verbeek AL, Kappelle AC, Andre Grotenhuis J, Leer JW (2007) Development of a model with which to predict the life expectancy of patients with spinal epidural metastases. Cancer 110:2042–2049
Bauer HC, Wedin R (1995) Survival after surgery for spinal and extremity metastases. Prognostication in 241 patients. Acta Orthop Scand 66:143–146
Chow E, Abdolell M, Panzarella T, Harris K, Bezjak A, Warde P, Tannock I (2009) Validation of a predictive model for survival in metastatic cancer patients attending an outpatient palliative radiotherapy clinic. Int J Rad Onc Biol Phys 73:280–287
Enkaoua EA, Doursounian L, Chatellier G, Mabesoone F, Aimard T, Saillant G (1997) Vertebral metastases. A critical appreciation of the prognostic Tokuhashi Score in a series of 71 cases. Spine 22:2293–2298
Falicov A, Fisher CG, Sparkes J, Boyd MC, Wing PC, Dvorak MF (2006) Impact of surgical intervention on quality of life in patients with spinal metastases. Spine 31:2849–2856
Hosono N, Ueda T, Tamura D (2005) Prognostic relevance of clinical symptoms in patients with spinal metastases. Clin Orthop Rel Res 436:196–201
Ibrahim A, Crockard A, Antonietti P et al (2008) Does spinal surgery improve the quality of life for those with extradural (spinal) osseous metastases? An international multicenter prospective observational study of 223 patients. J Neurosurg Spine 8:271–278
Jansson K, Bauer HC (2006) Survival, complications and outcome in 282 patients operated for neurological deficit due to thoracic or lumbar spinal metastases. Eur Spine J 15:196–202
Katagiri H, Takahashi M, Wakai K, Sugiura H, Kataoka T, Nakanishi K (2005) Prognostic factors and a scoring system for patients with skeletal metastasis. J Bone Joint Surg Br 87:698–703
Leithner A, Radl R, Gruber G, Hochegger M, Leithner K, Welkerling H, Rehak P, Windhager R (2008) Predictive value of seven preoperative prognostic scoring systems for spinal metastases. Eur Spine J 17:1488–1495
Patchell RA, Tibbs PA, Regine WF, Payne R, Saris S, Hrysio RJ, Mohiuddin M, Young B (2005) Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomized trial. Lancet 66:643–648
Sioutos PJ, Arbit E, Meshulam CF, Galicich JH (1995) Spinal metastases from solid tumors. Analysis of factors affecting survival. Cancer 76:1453–1459
Tatsui H, Onomura T, Morishita S, Oketa M, Inoue T (1996) Survival rates of patients with metastatic spinal cancer after scinitigraphic detection of abnormal radioactive accumulation. Spine 21:2143–2148
Tokuhashi Y, Matsuzaki H, Toriyama S, Kawano H, Ohsaka S (1990) Scoring system for the preoperative evaluation of metastatic spine tumor prognosis. Spine 15:1110–1113
Tokuhashi Y, Matsuzaki H, Oda H, Oshima M, Ryu J (2005) A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. Spine 30:2186–2191
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
Tomita K, Kawahara N, Kobayashi T, Yoshida A, Murakami H, Akamaru T (2001) Surgical strategy for spinal metastases. Spine 26:298–306
Ulmar B, Richter M, Cakir B, Muche R, Puhl W, Huch K (2005) The Tokuhashi score: significant predictive value for the life expectancy of patients with breast cancer with spinal metastases. Spine 30:2222–2226
Ulmar B, Naumann U, Catalkaya S, Muche R, Cakir B, Schmidt R, Reichel H, Huch K (2007a) Prognosis scores of Tokuhashi and Tomita for patients with spinal metastases of renal cancer. Ann Surg Oncol 14:998–1004
Ulmar B, Huch K, Naumann U, Catalkaya S, Cakir B, Gerstner S, Reichel H (2007b) Evaluation of the Tokuhashi prognosis score and its modifications in 217 patients with vertebral metastases. Eur J Surg Oncol 33:914–919
van der Linden YM, Dijkstra SP, Vonk EJ, Marijen CA, Leer JW (2005) Prediction of survival in patients with metastases in the spinal column. Results based on a randomized trial of radiotherapy. Cancer 103:320–328
Weigel B, Maghsudi M, Neumann C, Kretschmer R, Muller FJ, Nerlich M (1999) Surgical management of symptomatic spinal metastases. Spine 24:2240–2246
Acknowledgments
This study was supported by a French National Research and Clinical Hospital Project Grant and a National Health and Medical Research Council of Australia Fellowship Grant (Dr. G. Quan).
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Pointillart, V., Vital, JM., Salmi, R. et al. Survival prognostic factors and clinical outcomes in patients with spinal metastases. J Cancer Res Clin Oncol 137, 849–856 (2011). https://doi.org/10.1007/s00432-010-0946-0
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DOI: https://doi.org/10.1007/s00432-010-0946-0