Open AccessRelationship Between Visceral Metastases and Survival in Patients with Metastasis‐related Spinal Cord Compression
Author(s) -
Lun Dengxing,
Wang Xiaodong,
Ji Yudong,
Hu Yongcheng,
Yang Xionggang,
Yu Xiuchun,
Zhang Guochuan,
Zhuang Qingshan
Publication year - 2019
Publication title -
orthopaedic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.666
H-Index - 23
eISSN - 1757-7861
pISSN - 1757-7853
DOI - 10.1111/os.12465
Subject(s) - medicine , spinal cord compression , proportional hazards model , medical record , hazard ratio , metastasis , surgery , multivariate analysis , spinal cord , cancer , confidence interval , psychiatry
Objective To investigate whether visceral metastases have a significant impact on survival in patients with metastasis‐related spinal cord compression (MSCC), and to determine the difference in prognosis between patients with and without visceral metastases. Methods Three institutional databases were searched to identify all patients who had undergone spinal surgery for spinal metastases between March 2002 and June 2010. Data on patient characteristics including pre‐ and post‐operative medical conditions, were collected from medical records or by telephone follow‐up. Survival data were obtained either from medical records or by searching a governmental cancer registry. Results The mean age of study patients was 59.6 ± 10.5 years (range, 18–84 years), of whom 102 were male and 67 female. The median and mean postoperative survival times were 7.0 ± 0.5 (95% CI 6.0–8.0) months and 12.6 ± 1.2 (95% CI 10.1–15.0) months, respectively, in all patients, being 5.0 ± 0.5 (95% CI 4.0–6.0) months and 10.8 ± 2.4 (95% CI 6.1–15.5) months, respectively, for patients with visceral metastases and 7.0 ± 0.8 (95% CI 5.4–8.6) months and 13.0 ± 1.4 (95%CI 10.3–15.6) months, respectively, for patients without visceral metastases ( P = 0.87). These survival times did not differ significantly between groups. Multivariate Cox proportional hazard regressions showed that visceral metastases had no statistically significant association with survival ( P = 0.277), whereas rate of growth of primary tumor ( P = 0.003), preoperative Karnofsky performance status (KPS) ( P < 0.001), change in KPS ( P < 0.001), and Frankel grade ( P = 0.091) were independent prognostic factors in the whole cohort ( P = 0.005). Changes in KPS ( P = 0.001) and major complications ( P = 0.003) were significantly associated with survival in patients with visceral metastases, whereas rate of growth of primary tumor ( P = 0.016), change in KPS ( P = 0.001), and preoperative KPS ( P < 0.001) were significantly associated with survival in patients without visceral metastases. Conclusions Visceral metastases do not appear to predict the prognosis of patients with MSCC; thus, more aggressive surgery should be considered in patients with MSCC who have visceral metastases. Additionally, prognostic factors differ according to visceral metastases status in these patients.