TitleCharacteristics of Patients Who Survived < 3 Months or > 2 Years After Surgery for Spinal Metastases: Can We Avoid Inappropriate Patient Selection?
AuthorsVerlaan, Jorrit-Jan
Choi, David
Versteeg, Anne
Albert, Todd
Arts, Mark
Balabaud, Laurent
Bunger, Cody
Buchowski, Jacob Maciej
Chung, Chung Kee
Coppes, Maarten Hubert
Crockard, Hugh Alan
Depreitere, Bart
Fehlings, Michael George
Harrop, James
Kawahara, Norio
Kim, Eun Sang
Lee, Chong-Suh
Leung, Yee
Liu, Zhongjun
Martin-Benlloch, Antonio
Massicotte, Eric Maurice
Mazel, Christian
Meyer, Bernhard
Peul, Wilco
Quraishi, Nasir A.
Tokuhashi, Yasuaki
Tomita, Katsuro
Ulbricht, Christian
Wang, Michael
Oner, F. Cumhur
AffiliationUniv Med Ctr Utrecht, Room G-05-228,Heidelberglaan 100, NL-3584 CX Utrecht, Netherlands.
Med Ctr Haaglanden, The Hague, Netherlands.
Univ Groningen, Univ Med Ctr Groningen, Groningen, Netherlands.
Leiden Univ, Med Ctr, Leiden, Netherlands.
UCL, Natl Hosp Neurol & Neurosurg, London, England.
Charing Cross Hosp, London, England.
Musgrove Pk Hosp, Taunton, Somerset, England.
Queens Med Ctr, Nottingham, England.
Thomas Jefferson Univ & Hosp, Philadelphia, PA USA.
Washington Univ, St Louis, MO USA.
Univ Miami, Jackson Mem Hosp, Miami, FL 33136 USA.
Inst Mutualiste Montsouris, Paris, France.
Aarhus Univ Hosp, Aarhus, Denmark.
Seoul Natl Univ, Seoul, South Korea.
Sungkyunkwan Univ, Sch Med, Samsung Med Ctr, Seoul, South Korea.
Univ Hosp Leuven, Leuven, Belgium.
Toronto Western Hosp, Toronto, ON, Canada.
Kanazawa Med Univ Hosp, Kanazawa, Ishikawa, Japan.
Kanazawa Univ, Kanazawa, Ishikawa, Japan.
Nihon Univ, Sch Med, Tokyo, Japan.
Peking Univ Hosp, Beijing, Peoples R China.
Hosp Univ Dr Peset, Valencia, Spain.
Tech Univ Munich, Munich, Germany.
Issue Date2016
CitationJOURNAL OF CLINICAL ONCOLOGY.2016,34(25),3054-+.
AbstractPurpose 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. (C) 2016 by American Society of Clinical Oncology
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