Background
Methods
Patients
Survival analysis
Surgery and functional evaluation
Statistical analysis
Results
Patient characteristics and survival
Scoring system
Factors | Patients (n) | Survival | MOS (mo) |
P
| |
---|---|---|---|---|---|
6 mo (%) | 12 mo (%) | ||||
Age | |||||
≤ 57 years | 34 | 61 | 27 | 7.1 | 0.16 |
≥ 58 years | 30 | 42 | 18 | 4.8 | |
Gender | |||||
Female | 22 | 55 | 23 | 6.3 | 0.90 |
Male | 42 | 52 | 24 | 6.2 | |
Preoperative ambulatory status | |||||
Ambulatory | 33 | 64 | 32 | 8.8 | 0.003 |
Nonambulatory | 31 | 41 | 14 | 4.8 | |
Other bone metastases | |||||
No | 16 | 69 | 21 | 7.9 | 0.58 |
Yes | 48 | 47 | 23 | 4.9 | |
ECOG performance status | |||||
1–2 | 43 | 66 | 29 | 8.8 | <0.001 |
3–4 | 21 | 26 | 5 | 4.5 | |
Number of involved vertebrae | |||||
1–2 | 36 | 67 | 35 | 7.9 | 0.001 |
≥ 3 | 28 | 36 | 9 | 4.4 | |
Visceral metastases | |||||
No | 33 | 78 | 36 | 10.8 | 0.002 |
Yes | 31 | 27 | 10 | 4.3 | |
Interval from cancer diagnosis to surgery | |||||
≤ 80 days | 32 | 59 | 24 | 7.1 | 0.73 |
> 80 days | 32 | 47 | 22 | 5.5 | |
Time developing motor deficits | |||||
≤ 14 days | 30 | 30 | 7 | 3.9 | <0.001 |
> 14 days | 34 | 72 | 37 | 10.8 |
Factors | Simple cox regression | Multiple cox regression | ||
---|---|---|---|---|
HR (95 % CI) |
P
| HR (95 % CI) |
P
| |
Preoperative ambulatory status | 2.24 (1.30–3.86) | 0.004 | Excludeda
| |
ECOG performance status | 2.78 (1.54–5.02) | <0.001 | 2.18 (1.15–4.16) | 0.017 |
Number of involved vertebrae | 2.46 (1.39–4.35) | 0.002 | 2.05 (1.11–3.76) | 0.021 |
Visceral metastases | 2.29 (1.33–3.94) | 0.003 | 2.00 (1.10–3.62) | 0.022 |
Time developing motor deficits | 3.44 (1.90–6.22) | <0.001 | 2.70 (1.45–5.03) | 0.002 |
Factors | Patients (n) | HR | Scoring points |
---|---|---|---|
ECOG performance status | |||
1–2 | 43 | 1 | 1 |
2–4 | 21 | 2.78 | 3 |
Number of involved vertebrae | |||
1–2 | 36 | 1 | 1 |
≥ 3 | 28 | 2.46 | 2 |
Visceral metastases | |||
No | 33 | 1 | 1 |
Yes | 31 | 2.29 | 2 |
Time developing motor deficits | |||
< 14 days | 30 | 3.44 | 3 |
≥ 14 days | 34 | 1 | 1 |
Functional outcome
Groups | Scores | Patients(n) | Neurological status weeks postoperation |
P values | |
---|---|---|---|---|---|
Ambulatory | Nonambulatory | ||||
A | 4–5 | 22 | 19 | 3 |
P1 = 0.502 |
B | 6–7 | 23 | 17 | 6 |
P2 = 0.037 |
C | 8–10 | 19 | 8 | 11a
|
P3 = 0.003 |
Discussion
Scoring systems | MOS (m) | Suggestions | No. of LC (Total) | Spinal metastasis | Treatments | Parameters |
---|---|---|---|---|---|---|
Tokuhashi [9] | ||||||
Group A | 3 | Palliative surgery | 6 (64) | In general | All surgeryc
| PS; Extraspinal bone metastases; Metastases in the vertebral body; Metastases to major organs; primary tumor site; Spinal cord palsy |
Group B | 6 | - | ||||
Group C | 22 | Excisional surgery | ||||
Revised Tokuhashi [10] | ||||||
Group A | 4.9 | Conservation therapy | 26 (246) | In general | 164 patients was treated with surgery | PS; Extraspinal bone metastases; Metastases in the vertebral body; Metastases to major organs; Primary tumor site; Spinal cord palsy |
Group B | 9.5 | Palliative surgery | ||||
Group C | 19 | Excisional surgery | ||||
Tomita [11] | ||||||
Group A | 6 | Supportive care | 10 (67) | In general | 58 patients was treated with surgery | No. of extraspinal bone metastases; Metastases to major internal organs; Primary tumor site; Spinal cord palsy |
Group B | 15 | Palliative surgery | ||||
Group C | 24 | Intralesional/marginal | ||||
Group D | 50 | Excisional surgery | ||||
Van der Linden [12] | ||||||
Group A | 4.8 | Radiotherapy | 68 (324) | No MSCC | Radiotherapy alone | KPS; Primary tumor; Visceral metastases |
Group B | 13.1 | Radiotherapy | ||||
Group C | 18.3 | Surgery | ||||
Sioutos [13] | ||||||
3b
| 1.5 | No surgery | 45 (109) | MSCC | All surgeryd
| Preoperative neurological status; Anatomic site of primary carcinoma; No. of vertebral bodies involved |
2b
| 6.0 | No surgery | ||||
1b
| 11.2 | Radical surgery | ||||
0b
| 18.0 | Radical surgery | ||||
Bauer [14] | ||||||
Group A | - | No surgery | 6 (88) | In general | All surgerye
| Visceral metastases; No. of skeletal metastases; Primary cancer type. |
Group B | - | Dorsal surgery | ||||
Group C | - | Ventral-dorsal surgery | ||||
Bartels [15] | ||||||
Not reported | 28 (219) | In general | Radiotherapy alone | Sex; Location of the primary lesion; Curative treatment of the primary tumor; Location of the spinal metastasis; KPS | ||
Ours | ||||||
Group A | 12.8 | More radical surgery | 64 (64) | MSCC | All surgerye
| ECOG performance status; No. of involved vertebrae; Visceral metastases; Time developing motor deficits. |
Group B | 6.4 | Depressive surgery | ||||
Group C | 2.7 | Supportive care |