Jonathan N Sellin1, Dima Suki2, Viraat Harsh1, Benjamin D Elder3, Daniel K Fahim4, Ian E McCutcheon2, Ganesh Rao2, Laurence D Rhines2, Claudio E Tatsui2. 1. Department of Neurosurgery, Baylor College of Medicine, Houston; 2. Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas; 3. Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland; and. 4. Department of Neurosurgery, Oakland University William Beaumont School of Medicine, Rochester, Michigan.
Abstract
OBJECT: Spinal metastases account for the majority of bone metastases from thyroid cancer. The objective of the current study was to analyze a series of consecutive patients undergoing spinal surgery for thyroid cancer metastases in order to identify factors that influence overall survival. METHODS: The authors retrospectively reviewed the records of all patients who underwent surgery for spinal metastases from thyroid cancer between 1993 and 2010 at the University of Texas MD Anderson Cancer Center. RESULTS: Forty-three patients met the study criteria. Median overall survival was 15.4 months (95% CI 2.8-27.9 months) based on the Kaplan-Meier method. The median follow-up duration for the 4 patients who were alive at the end of the study was 39.4 months (range 1.7-62.6 months). On the multivariate Cox analysis, progressive systemic disease at spine surgery and postoperative complications were associated with worse overall survival (HR 8.98 [95% CI 3.46-23.30], p < 0.001; and HR 2.86 [95% CI 1.30-6.31], p = 0.009, respectively). Additionally, preoperative neurological deficit was significantly associated with worse overall survival on the multivariate analysis (HR 3.01 [95% CI 1.34-6.79], p = 0.008). Conversely, preoperative embolization was significantly associated with improved overall survival on the multivariate analysis (HR 0.43 [95% CI 0.20-0.94], p = 0.04). Preoperative embolization and longer posterior construct length were significantly associated with fewer and greater complications, respectively, on the univariate analysis (OR 0.24 [95% CI 0.06-0.93] p = 0.04; and OR 1.24 [95% CI 1.02-1.52], p = 0.03), but not the multivariate analysis. CONCLUSIONS: Progressive systemic disease, postoperative complications, and preoperative neurological deficits were significantly associated with worse overall survival, while preoperative spinal embolization was associated with improved overall survival. These factors should be taken into consideration when considering such patients for surgery. Preoperative embolization and posterior construct length significantly influenced the incidence of postoperative complications only on the univariate analysis.
OBJECT: Spinal metastases account for the majority of bone metastases from thyroid cancer. The objective of the current study was to analyze a series of consecutive patients undergoing spinal surgery for thyroid cancer metastases in order to identify factors that influence overall survival. METHODS: The authors retrospectively reviewed the records of all patients who underwent surgery for spinal metastases from thyroid cancer between 1993 and 2010 at the University of Texas MD Anderson Cancer Center. RESULTS: Forty-three patients met the study criteria. Median overall survival was 15.4 months (95% CI 2.8-27.9 months) based on the Kaplan-Meier method. The median follow-up duration for the 4 patients who were alive at the end of the study was 39.4 months (range 1.7-62.6 months). On the multivariate Cox analysis, progressive systemic disease at spine surgery and postoperative complications were associated with worse overall survival (HR 8.98 [95% CI 3.46-23.30], p < 0.001; and HR 2.86 [95% CI 1.30-6.31], p = 0.009, respectively). Additionally, preoperative neurological deficit was significantly associated with worse overall survival on the multivariate analysis (HR 3.01 [95% CI 1.34-6.79], p = 0.008). Conversely, preoperative embolization was significantly associated with improved overall survival on the multivariate analysis (HR 0.43 [95% CI 0.20-0.94], p = 0.04). Preoperative embolization and longer posterior construct length were significantly associated with fewer and greater complications, respectively, on the univariate analysis (OR 0.24 [95% CI 0.06-0.93] p = 0.04; and OR 1.24 [95% CI 1.02-1.52], p = 0.03), but not the multivariate analysis. CONCLUSIONS: Progressive systemic disease, postoperative complications, and preoperative neurological deficits were significantly associated with worse overall survival, while preoperative spinal embolization was associated with improved overall survival. These factors should be taken into consideration when considering such patients for surgery. Preoperative embolization and posterior construct length significantly influenced the incidence of postoperative complications only on the univariate analysis.
Authors: Kristin J Redmond; Scott Robertson; Simon S Lo; Scott G Soltys; Samuel Ryu; Todd McNutt; Samuel T Chao; Yoshiya Yamada; Amol Ghia; Eric L Chang; Jason Sheehan; Arjun Sahgal Journal: Int J Radiat Oncol Biol Phys Date: 2016-09-17 Impact factor: 7.038
Authors: Kristin J Redmond; Simon S Lo; Scott G Soltys; Yoshiya Yamada; Igor J Barani; Paul D Brown; Eric L Chang; Peter C Gerszten; Samuel T Chao; Robert J Amdur; Antonio A F De Salles; Matthias Guckenberger; Bin S Teh; Jason Sheehan; Charles R Kersh; Michael G Fehlings; Moon-Jun Sohn; Ung-Kyu Chang; Samuel Ryu; Iris C Gibbs; Arjun Sahgal Journal: J Neurosurg Spine Date: 2016-11-11