Jorrit-Jan Verlaan1, David Choi2, Anne Versteeg2, Todd Albert2, Mark Arts2, Laurent Balabaud2, Cody Bunger2, Jacob Maciej Buchowski2, Chung Kee Chung2, Maarten Hubert Coppes2, Hugh Alan Crockard2, Bart Depreitere2, Michael George Fehlings2, James Harrop2, Norio Kawahara2, Eun Sang Kim2, Chong-Suh Lee2, Yee Leung2, Zhongjun Liu2, Antonio Martin-Benlloch2, Eric Maurice Massicotte2, Christian Mazel2, Bernhard Meyer2, Wilco Peul2, Nasir A Quraishi2, Yasuaki Tokuhashi2, Katsuro Tomita2, Christian Ulbricht2, Michael Wang2, F Cumhur Oner2. 1. Jorrit-Jan Verlaan, Anne Versteeg, and F. Cumhur Oner, University Medical Center Utrecht, Utrecht; Mark Arts, Medical Center Haaglanden, The Hague; Maarten Hubert Coppes, University Medical Center Groningen, Groningen; Wilco Peul, Leiden University Medical Centre, Leiden, the Netherlands; David Choi and Hugh Alan Crockard, The National Hospital for Neurology and Neurosurgery, University College London; Christian Ulbricht, Charing Cross Hospital, London; Yee Leung, Musgrove Park Hospital, Taunton; Nasir A. Quraishi, Queens Medical Centre, Nottingham, United Kingdom; Todd Albert and James Harrop, Thomas Jefferson University and Hospitals, Philadelphia, PA; Jacob Maciej Buchowski, Washington University, St. Louis, MO; Michael Wang, Jackson Memorial Hospital, University of Miami, Miami, FL; Laurent Balabaud and Christian Mazel, L'Institut Mutualiste Montsouris, Paris, France; Cody Bunger, University Hospital of Aarhus, Aarhus, Denmark; Chung Kee Chung, Seoul National University; Eun Sang Kim and Chong-Suh Lee, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Bart Depreitere, University Hospital Leuven, Leuven, Belgium; Michael George Fehlings and Eric Maurice Massicotte, Toronto Western Hospital, Toronto, ON, Canada; Norio Kawahara, Kanazawa Medical University Hospital; Katsuro Tomita, Kanazawa University, Kanazawa; Yasuaki Tokuhashi, Nihon University School of Medicine, Tokyo, Japan; Zhongjun Liu, Peking University Hospital, Beijing, People's Republic of China; Antonio Martin-Benlloch, Hospital Universitario Dr Peset, Valencia, Spain; and Bernhard Meyer, Technical University of Munich, Munich, Germany. j.j.verlaan@umcutrecht.nl. 2. Jorrit-Jan Verlaan, Anne Versteeg, and F. Cumhur Oner, University Medical Center Utrecht, Utrecht; Mark Arts, Medical Center Haaglanden, The Hague; Maarten Hubert Coppes, University Medical Center Groningen, Groningen; Wilco Peul, Leiden University Medical Centre, Leiden, the Netherlands; David Choi and Hugh Alan Crockard, The National Hospital for Neurology and Neurosurgery, University College London; Christian Ulbricht, Charing Cross Hospital, London; Yee Leung, Musgrove Park Hospital, Taunton; Nasir A. Quraishi, Queens Medical Centre, Nottingham, United Kingdom; Todd Albert and James Harrop, Thomas Jefferson University and Hospitals, Philadelphia, PA; Jacob Maciej Buchowski, Washington University, St. Louis, MO; Michael Wang, Jackson Memorial Hospital, University of Miami, Miami, FL; Laurent Balabaud and Christian Mazel, L'Institut Mutualiste Montsouris, Paris, France; Cody Bunger, University Hospital of Aarhus, Aarhus, Denmark; Chung Kee Chung, Seoul National University; Eun Sang Kim and Chong-Suh Lee, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Bart Depreitere, University Hospital Leuven, Leuven, Belgium; Michael George Fehlings and Eric Maurice Massicotte, Toronto Western Hospital, Toronto, ON, Canada; Norio Kawahara, Kanazawa Medical University Hospital; Katsuro Tomita, Kanazawa University, Kanazawa; Yasuaki Tokuhashi, Nihon University School of Medicine, Tokyo, Japan; Zhongjun Liu, Peking University Hospital, Beijing, People's Republic of China; Antonio Martin-Benlloch, Hospital Universitario Dr Peset, Valencia, Spain; and Bernhard Meyer, Technical University of Munich, Munich, Germany.
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.
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.
Authors: David J Cote; Hormuzdiyar H Dasenbrock; William B Gormley; Timothy R Smith; Ian F Dunn Journal: World Neurosurg Date: 2019-05-11 Impact factor: 2.104
Authors: Nicolas Dea; Anne L Versteeg; Arjun Sahgal; Jorrit-Jan Verlaan; Raphaële Charest-Morin; Laurence D Rhines; Daniel M Sciubba; James M Schuster; Michael H Weber; Aron Lazary; Michael G Fehlings; Michelle J Clarke; Paul M Arnold; Stefano Boriani; Chetan Bettegowda; Ilya Laufer; Ziya L Gokaslan; Charles G Fisher Journal: Neurosurgery Date: 2020-08-01 Impact factor: 4.654
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