Survival Analysis of 254 Patients After Manifestation of Spinal Metastases

Wibmer, Christine; Leithner, Andreas; Hofmann, Gunter; Clar, H. E.; Kapitan, Magdalena; Berghold, Andrea; Windhager, Reinhard

doi:10.1097/brs.0b013e3182011f84

Cited by 151 publications

(104 citation statements)

References 26 publications

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“…We agree with Wibmer et al [12] that the primary tumor classifications are not up to date. However, based on survival data in this study, the conclusion that patients suffering from kidney cancer have a prognosis comparable to those with breast cancer cannot be followed.…”

Section: Discussionsupporting

confidence: 93%

“…If a patient is considered fit enough to undergo metastasectomy, survival will most likely be prolonged based on their general condition and not the removal of the visceral metastasis. A recent retrospective study of 504 breast cancer patients irradiated for metastatic spinal cord compression by Rades et al [13] also found a strong negative effect on survival if visceral metastases were present, similar to Wibmer et al [12], Yamashita et al [14] and Crnalic et al [15].…”

Section: Discussionmentioning

confidence: 58%

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

et al. 2013

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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 KaplanMeier 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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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 58%

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

et al. 2013

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“…In both situations, there is wide variation in prognostic factors. We found similar survival in patients treated with surgery plus RT and in those treated with RT alone 5,6,26 .…”

Section: Discussionsupporting

confidence: 61%

Survival analysis in patients with metastatic spinal disease: the influence of surgery, histology, clinical and neurologic status

Oliveira

Rotta

Botelho

2015

Arq. Neuro-Psiquiatr.

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The spine is the most common site for skeletal metastasis in patients with malignancy. Approximately half of all patients with an advanced malignancy have evidence of spinal involvement. Surgical treatment remains a source of debate, and prognostic factors need to be well established to allow an appropriate decision regarding treatment modalities 1,2,3,4,5 .Vertebral involvement in such patients is associated with worse morbidity and mortality rates, impairing prognosis. Quantification of vertebral involvement, vertebral canal invasion, neurological status, general health status, and malignancy prognosis determined by primary tumor histology are paramount factors for surgical planning and definition of therapeutic targets 6,7,8,9,10 .We conducted a survival analysis in a sample of patients with metastatic spinal disease to determine factors associated with survival. METHODThe study sample consisted of patients with vertebral metastases consecutively admitted from July 2010 to January ABSTRACTSpine is the most common site for skeletal metastasis in patients with malignancy. Vertebral involvement quantification, neurological status, general health status and primary tumor histology are factors to set surgical planning and therapeutic targets. We evaluated the impact of general clinical and neurological status, histologic type and surgery in survival. Method: The study sample consisted of consecutive patients admitted from July 2010 to January 2013 for treatment. Results: Sixty eight patients were evaluated. 23 were female and 45 were male. Main primary neoplasic sites were: breast, prostate, lung/pleura and linfoproliferative. Thirty three out of 68 received surgical treatment, 2 received percutaneous biopsy and 33 had nonsurgical treatment. Survival: Log Rank curves revealed no statistical significant difference according to histological type, surgical approach and Frankel Score. Karnofsky Score was statistically different. Conclusion: Histological type and clinical status were statistically associated with life expectancy in vertebral metastatic disease.Keywords: neoplasm metastasis, spinal diseases, prognosis. RESUMOA coluna vertebral é o sítio mais comum de metastases ósseas. A quantificação do acometimento vertebral, o status neurológico, status clínico e histologia do tumor primário são fatores importantes para planejamento cirúrgico e metas terapêuticas. Nós avaliamos o impacto do status clinico geral e neurológico, tipo histológico e cirurgia na sobrevida de pacientes com metástases espinhais. Método: A amostra consistiu de pacientes consecutivamente admitidos de Julho de 2010 a Janeiro de 2013. Resultados: Sessenta e oito pacientes foram avaliados. 23 eram mulheres e 45 eram homens. Os principais sítios primários foram mama, próstata, pulmão e linfoproliferativos. Trinta e três realizaram tratamento cirúrgico, 2 realizaram biópsia percutânea e 33 tiveram tratamento conservador e radioterapia. Conclusão: As curvas Log Rank não revelaram significância quanto à cirurgia e escore de Frankel, mas revelaram as...

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“…However, every score, even with its particu larities, requires complete evaluation of the systemic disease, including a histological diagnosis. Several authors have demonstrated that the primary tumor site is the most important prog nostic factor for patient survival, and this is well accepted 19 . However, in vertebral metastasis with spinal cord compres sion, there is an urgent need for decisionmaking, and the histo logical diagnosis and tumor staging data require time that is not available before treatment 7 .…”

Section: Discussionmentioning

confidence: 93%

Tokuhashi Scoring System has limited applicability in the majority of patients with spinal cord compression secondary to vertebral metastasis

Oliveira

Barros

Rotta

et al. 2013

Arq. Neuro-Psiquiatr.

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Spine is the primary bone site affected by systemic metastasis. Although there are scales that attempt to manage these patients, their real applicability is unknown. The Tokuhashi Scoring System (TSS) is a widely used prognostic tool. At the time of treatment, the data necessary to complete TSS may be incomplete, making its application impossible. Objective To evaluate the number of TSS scores completed by the time the clinical therapeutic decision was made. Methods From July 2010 to January 2012, we selected patients who were diagnosed with spinal metastases. Results Sixty spinal metastasis patients (21 female, 39 male) were evaluated between July 2010 and January 2012. At the time of the treatment decision, only 25% of the patients had completed the TSS items. Conclusion In the majority of patients with vertebral metastasis, TSS variables cannot be applied.

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Survival Analysis of 254 Patients After Manifestation of Spinal Metastases

Abstract: According to this analysis, the Bauer and the Bauer modified scores are the most reliable systems for predicting survival. Since the Bauer modified score furthermore consists of only four positive prognostic factors, we emphasize its impact and simplicity.

Cited by 151 publications

References 26 publications

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

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

Survival analysis in patients with metastatic spinal disease: the influence of surgery, histology, clinical and neurologic status

Tokuhashi Scoring System has limited applicability in the majority of patients with spinal cord compression secondary to vertebral metastasis

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