Characteristics of patients who survived <, 3 months or >2 years after surgery for spinal metastases: Can we avoid inappropriate patient selection?

Jorrit Jan Verlaan, David Choi, Anne Versteeg, Todd Albert, Mark Arts, Laurent Balabaud, Cody Bunger, Jacob Maciej Buchowski, Chung Kee Chung, Maarten Hubert Coppes, Hugh Alan Crockard, Bart Depreitere, Michael George Fehlings, James Harrop, Norio Kawahara, Eun Sang Kim, Chong Suh Lee, Yee Leung, Zhongjun Liu, Antonio Martin-BenllochEric Maurice Massicotte, Christian Mazel, Bernhard Meyer, Wilco Peul, Nasir A. Quraishi, Yasuaki Tokuhashi, Katsuro Tomita, Christian Ulbricht, Michael Wang, F. Cumhur Oner

Research output: Contribution to journalArticlepeer-review

39 Scopus citations

Abstract

Purpose Survival after metastatic cancer has improved at the cost of increased presentation with metastatic spinal disease. For patients with pathologic spinal fractures and/or spinal cord compression, surgical intervention may relieve pain and improve quality of life. Surgery is generally considered to be inappropriate if anticipated survival is , 3 months. The aim of this international multicenter study was to analyze data from patients who died within 3 months or 2 years after surgery, to identify preoperative factors associated with poor or good survival, and to avoid inappropriate selection of patients for surgery in the future. Patients and Methods A total of 1,266 patients underwent surgery for impending pathologic fractures and/or neurologic deficits and were prospectively observed. Data collected included tumor characteristics, preoperative fitness (American Society of Anesthesiologists advisory [ASA]), neurologic status (Frankel scale), performance (Karnofsky performance score [KPS]), and quality of life (EuroQol five-dimensions questionnaire [EQ-5D]). Outcomes were survival at 3 months and 2 years postsurgery. Univariable and multivariable logistic regression analyses were used to find preoperative factors associated with short-term and long-term survival. Results In univariable analysis, age, emergency surgery, KPS, EQ-5D, ASA, Frankel, and Tokuhashi/Tomita scores were significantly associated with short survival. In multivariable analysis, KPS and age were significantly associated with short survival (odds ratio [OR], 1.36; 95% CI, 1.15 to 1.62; and OR, 1.14; 95% CI, 1.02 to 1.27, respectively). Associated with longer survival in univariable analysis were age, number of levels included in surgery, KPS, EQ-5D, Frankel, and Tokuhashi/Tomita scores. In multivariable analysis, the number of levels included in surgery (OR, 1.21; 95% CI, 1.06 to 1.38) and primary tumor type were significantly associated with longer survival. Conclusion Poor performance status at presentation is the strongest indicator of poor short-term survival, whereas low disease load and favorable tumor histology are associated with longer-term survival.

Original languageEnglish (US)
Pages (from-to)3054-3061
Number of pages8
JournalJournal of Clinical Oncology
Volume34
Issue number25
DOIs
StatePublished - Sep 1 2016
Externally publishedYes

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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