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Risk factors for survival of 106 surgically treated patients with symptomatic spinal epidural metastases

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Abstract

Purpose

Evaluation of risk factors for survival in patients surgically treated for symptomatic spinal epidural metastases (SEM).

Methods

One hundred and six patients who were surgically treated for symptomatic SEM in a 10-year period in two cooperatively working hospitals were retrospectively studied for nine risk factors: age, gender, site of the primary tumor, location of the symptomatic spinal metastasis, functional and neurologic status, the presence of visceral metastases and the presence of other spinal and extraspinal bone metastases. Analysis was performed using the Kaplan–Meier method, univariate log-rank tests and Cox-regression models.

Results

Overall median survival was 10.7 months (0.2–107.5 months). Overall 30-day complication rate was 33 %. Multivariate Cox-regression analysis showed that fast growing primary tumors (HR 3.1, 95 % CI 1.6–6.2, p = 0.001), the presence of visceral metastases (HR 1.7, 95 % CI 1.0–2.9, p = 0.033) and a low performance status (HR 2.7, 95 % CI 1.1–6.6, p = 0.025) negatively influenced the survival.

Conclusion

Primary tumor type, presence of visceral metastases and performance status are significant predictors for survival after surgery for symptomatic SEM and should be evaluated before deciding on the extent of treatment. More accurate prediction models are needed to select the best treatment option for the individual patient.

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Acknowledgments

The authors would like to thank D.J. Lobatto and W.S.F.J. Tummers for their invaluable support in creating the database.

Conflict of interest

 None of the authors have a conflict of interest to declare.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC, Leiden, The Netherlands

    L. Bollen, T. J. T. Hazen & P. D. S. Dijkstra

  2. Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands

    W. Pondaag & W. C. Peul

  3. Department of Neurosurgery, Medical Center Haaglanden, The Hague, The Netherlands

    G. C. W. de Ruiter & M. P. Arts

  4. Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands

    M. Fiocco

Authors
  1. L. Bollen
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  2. G. C. W. de Ruiter
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  3. W. Pondaag
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  4. M. P. Arts
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  5. M. Fiocco
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  6. T. J. T. Hazen
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  7. W. C. Peul
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  8. P. D. S. Dijkstra
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Corresponding author

Correspondence to L. Bollen.

Additional information

Part of the Leiden—The Hague Spinal Intervention Prognostic Study (SIPS) group.

Appendix

Appendix

If a risk factor is divided into more than two categories, pairwise grouped analysis was performed using log-rank tests. Data presented are p values. For each category, number of patients and median survival in months with 95 % confidence interval is given (see Tables 8, 9, 10, 11, 12, 13, 14, 15, 16).

Table 8 Grouped analysis modified Tomita primary tumor classification
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Table 9 Grouped analysis revised Tokuhashi primary tumor classification
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Table 10 Grouped analysis modified van der Linden primary tumor classification
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Table 11 Grouped analysis modified Bauer primary tumor classification
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Table 12 Grouped analysis Tokuhashi/van der Linden Karnofsky performance status classification
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Table 13 Grouped analysis Tomita/Tokuhashi visceral metastases classification
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Table 14 Grouped analysis Tokuhashi extraspinal bone metastases classification
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Table 15 Grouped analysis Tokuhashi spinal metastases classification
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Table 16 Grouped analysis Tokuhashi Frankel classification
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Bollen, L., de Ruiter, G.C.W., Pondaag, W. et al. Risk factors for survival of 106 surgically treated patients with symptomatic spinal epidural metastases. Eur Spine J 22, 1408–1416 (2013). https://doi.org/10.1007/s00586-013-2726-4

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  • DOI: https://doi.org/10.1007/s00586-013-2726-4

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