Long-term survivors after surgical management of metastatic spinal cord compression

• Published in: European spine journal Vol. 24; no. 1; pp. 209 - 215
• Main Authors: Tabouret, Emeline, Gravis, G., Cauvin, C., Loundou, A., Adetchessi, T., Fuentes, S.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.01.2015; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Antineoplastic Agents - therapeutic use; Bone Neoplasms - secondary; Female; Humans; Karnofsky Performance Status; Male; Medicine; Medicine & Public Health; Middle Aged; Neurosurgery; Original Article; Retrospective Studies; Spinal Cord Compression - etiology; Spinal Cord Compression - surgery; Spinal Neoplasms - mortality; Spinal Neoplasms - secondary; Spinal Neoplasms - surgery; Surgical Orthopedics; Time-to-Treatment; Weight Loss; Young Adult; Long-term survivor; Recursive partitioning analysis; Metastatic spinal cord compression; Predictive factor; Prognostic score
• ISSN: 0940-6719; 1432-0932
• DOI: 10.1007/s00586-014-3676-1

Purpose Metastatic spinal cord compression (MSCC) incidences are increasing. Our objective was to identify predictive factors involved in long-term survival after use of a surgical approach. Methods We retrospectively analyzed all patients referred to our institution for MSCC who underwent surgery ( N  = 138). We identified patients with an overall survival (OS) rate greater than 2 years, compared their characteristics to the remaining patients, and performed recursive partitioning analysis (RPA). Results Median OS was 7.8 months (95 % confidence interval 4.4–11.2). Thirty-nine patients presented with OS ≥2 years. A comparative analysis found significant differences concerning the delay (first symptom–surgery, p  < 0.001), number of systemic ( p  = 0.001) or bone metastases ( p  = 0.013), Karnofsky performance status (KPS) ( p  = 0.006), Frankel ( p  = 0.025), ASA scores ( p  < 0.001), weight loss ( p  = 0.003), hyperalgia ( p  = 0.002), chemotherapy use ( p  = 0.034), and primary tumor ( p  < 0.001). RPA classification identified six prognostic classes based on the ASA score, primary type, KPS, and systemic metastases. Conclusion Long-term metastatic cancer survivor patients are an increasing population with specific characteristics.