Emeline Tabouret1, Cécile Cauvin1, Stéphane Fuentes2, Benjamin Esterni3, Tarek Adetchessi2, Naji Salem4, Anne Madroszyk1, Anthony Gonçalves1, François Casalonga5, Gwenaelle Gravis6. 1. Department of Medical Oncology, Institut Paoli Calmettes, 232 bd de sainte Marguerite, 13009 Marseille, France. 2. Department of Neurosurgery, APHM, Hopital de la Timone, 264 rue Saint Pierre, 13005 Marseille, France. 3. Department of Biostatistics, Institut Paoli Calmettes, 232 Bd Sainte Marguerite, 13009 Marseille, France. 4. Department of Radiotherapy, Institut Paoli Calmettes, 232 Bd Sainte Marguerite, 13009 Marseille, France. 5. Department of Radiology, Institut Paoli Calmettes, 232 Bd Sainte Marguerite, 13009 Marseille, France. 6. Department of Medical Oncology, Institut Paoli Calmettes, 232 bd de sainte Marguerite, 13009 Marseille, France. Electronic address: gravisg@ipc.unicancer.fr.
Abstract
BACKGROUND CONTEXT: The incidence of metastatic spinal cord compression (MSCC) is increasing, paralleling increasing life expectancy of patients. However, management of MSCC and relevance of scoring systems remain controversial. PURPOSE: The aims of our study were to analyze the feasibility and outcomes of spinal surgery, to identify prognostic factors for survival, and to assess the accuracy of scoring systems in patients with malignancies associated with MSCC. STUDY DESIGN: Retrospective analysis of all patients with MSCC operated in our institution. METHODS: Outcomes of surgery, prognostic factors for survival, and relevance of Tomita and Tokuhashi scores were investigated. RESULTS: One hundred forty-eight patients were included: 66% were hyperalgic (pain score >6) and Frankel score (FS) was decreased in 49%. Seventy-three percent of patients had laminectomy with spinal fixation. After surgery, pain decreased in 75% of cases, FS was improved in 31%, and 92% of patients were ambulatory. Postoperative complication rate was 16%. Median overall survival (OS) was 8.9 months (95% confidence interval, 4.4-13). Only Tokuhashi score was relevant, but predictive accuracy of survival was just 51%. In univariate analyses, hyperalgia (p=.001), primary tumor site, extrabone metastases (p<.001), Karnofsky performance status (KPS) less than 70 (p<.001), poor American Society of Anesthesiologist (ASA) score (p<.001) or FS (p=.01), and absence of postoperative chemotherapy (p<.001) were associated with shorter OS. In multivariate analysis, only extrabone metastases (p=.004), KPS (p=.001), and ASA score (p=.007) remained significantly associated with OS. CONCLUSIONS: Surgery for MSCC is associated with limited morbidity, improved autonomy, and pain relief. Usual scores do not seem relevant, whereas ASA score, KPS, and extrabone metastases are significantly associated with OS.
BACKGROUND CONTEXT: The incidence of metastatic spinal cord compression (MSCC) is increasing, paralleling increasing life expectancy of patients. However, management of MSCC and relevance of scoring systems remain controversial. PURPOSE: The aims of our study were to analyze the feasibility and outcomes of spinal surgery, to identify prognostic factors for survival, and to assess the accuracy of scoring systems in patients with malignancies associated with MSCC. STUDY DESIGN: Retrospective analysis of all patients with MSCC operated in our institution. METHODS: Outcomes of surgery, prognostic factors for survival, and relevance of Tomita and Tokuhashi scores were investigated. RESULTS: One hundred forty-eight patients were included: 66% were hyperalgic (pain score >6) and Frankel score (FS) was decreased in 49%. Seventy-three percent of patients had laminectomy with spinal fixation. After surgery, pain decreased in 75% of cases, FS was improved in 31%, and 92% of patients were ambulatory. Postoperative complication rate was 16%. Median overall survival (OS) was 8.9 months (95% confidence interval, 4.4-13). Only Tokuhashi score was relevant, but predictive accuracy of survival was just 51%. In univariate analyses, hyperalgia (p=.001), primary tumor site, extrabone metastases (p<.001), Karnofsky performance status (KPS) less than 70 (p<.001), poor American Society of Anesthesiologist (ASA) score (p<.001) or FS (p=.01), and absence of postoperative chemotherapy (p<.001) were associated with shorter OS. In multivariate analysis, only extrabone metastases (p=.004), KPS (p=.001), and ASA score (p=.007) remained significantly associated with OS. CONCLUSIONS: Surgery for MSCC is associated with limited morbidity, improved autonomy, and pain relief. Usual scores do not seem relevant, whereas ASA score, KPS, and extrabone metastases are significantly associated with OS.
Authors: Andrew J Schoenfeld; Marco L Ferrone; Peter G Passias; Justin A Blucher; Lauren B Barton; John H Shin; Mitchel B Harris; Joseph H Schwab Journal: Spine J Date: 2019-05-22 Impact factor: 4.166
Authors: Carmine Zoccali; Jesse Skoch; Christina M Walter; Mohammad Torabi; Mark Borgstrom; Ali A Baaj Journal: Eur Spine J Date: 2015-12-01 Impact factor: 3.134
Authors: C Bouthors; S Prost; C Court; B Blondel; Y P Charles; S Fuentes; H P Mousselard; C Mazel; C H Flouzat-Lachaniette; P Bonnevialle; F Saihlan Journal: Support Care Cancer Date: 2019-08-09 Impact factor: 3.603