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Cox K, Ahmed H, Saha P, Liu WK, Aitken K, Bernard J, Bishop T, Minhas P, Papadopoulos M, Johnston F, Piggott A, Pereira E, Lui D, Afshar M. Six-Month Survivorship Prediction in Spinal Metastatic Patients by Oncologists Shows Reliable Prognostication. Global Spine J 2025; 15:961-968. [PMID: 38009792 PMCID: PMC11877491 DOI: 10.1177/21925682231218712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
STUDY DESIGN A retrospective analysis of oncologist-provided prognoses vs actual survival outcomes of patients referred with Metastatic spinal cord compression (MSCC) to a supra-regional multidisciplinary team (MDT). OBJECTIVES Prognostic scoring systems, such as the revised Tokuhashi, are commonly used to help guide the treatment of MSCC. However, scoring systems do not accommodate for the improved outcomes of contemporary cancer therapy. Oncologist-provided prognoses play an important role in real world rapid decision making. There is a paucity of evidence assessing the accuracy of the oncologist-provided prognosis. We conducted a retrospective study to evaluate this. METHODS Data was captured between January 2015 and December 2018. Patients were split into 2 groups: Group 1 (prognosis estimated <6 months) and Group 2 (prognosis estimated >6 months). Median overall survival (mOS) and hazard ratio for death (HR) was assessed. Receiver operating characteristic (ROC) analysis was performed to assess the accuracy of the oncologist's prognosis. RESULTS 829 patients were included. mOS in Group 1 was 5.8 months (95% CI 4.2-7.4 m), and in Group 2 mOS was not reached. Log rank test gave a Chi2 of 131 (P < .001). Cox regression analysis revealed a HR of .30 (P < .001). Area under the ROC curve was 78%. CONCLUSIONS Oncologist-provided prognosis is accurate in this cohort of unselected, consecutive MSCC patients. It reduced reliance on scoring systems that can become outdated. Given the rapid progress in cancer treatment, the oncologist's prognostic prediction is integral in efficient and effective MSCC management to help rapidly determine surgical candidacy.
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Affiliation(s)
- Kofi Cox
- Department of Medicine, St. George’s University of London, London, UK
| | - Hassam Ahmed
- Department of Medicine, St. George’s University of London, London, UK
| | - Priyanshu Saha
- Department of Medicine, St. George’s University of London, London, UK
| | - Wing Kin Liu
- Department of Oncology, St. George’s University Hospitals NHS Foundation Trust, London, UK
| | | | - Jason Bernard
- Department of Complex Neurosurgery, Atkinson Morley Wing, St. George’s University Hospitals NHS Foundation Trust, London, UK
| | - Timothy Bishop
- Department of Complex Neurosurgery, Atkinson Morley Wing, St. George’s University Hospitals NHS Foundation Trust, London, UK
| | - Pawan Minhas
- Department of Complex Neurosurgery, Atkinson Morley Wing, St. George’s University Hospitals NHS Foundation Trust, London, UK
| | - Marios Papadopoulos
- Department of Complex Neurosurgery, Atkinson Morley Wing, St. George’s University Hospitals NHS Foundation Trust, London, UK
| | - Francis Johnston
- Department of Complex Neurosurgery, Atkinson Morley Wing, St. George’s University Hospitals NHS Foundation Trust, London, UK
| | - Alicia Piggott
- Department of Complex Neurosurgery, Atkinson Morley Wing, St. George’s University Hospitals NHS Foundation Trust, London, UK
| | - Erlick Pereira
- Department of Complex Neurosurgery, Atkinson Morley Wing, St. George’s University Hospitals NHS Foundation Trust, London, UK
| | - Darren Lui
- Department of Complex Neurosurgery, Atkinson Morley Wing, St. George’s University Hospitals NHS Foundation Trust, London, UK
| | - Mehran Afshar
- Department of Oncology, St. George’s University Hospitals NHS Foundation Trust, London, UK
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Ujkic L, Sutanto R, Knöll P, Zarghooni K, Rosenbrock J, Walter S. [Acute spinal cord compression under systemic therapy - radiotherapy or surgery?]. Aktuelle Urol 2024; 55:50-53. [PMID: 37758040 DOI: 10.1055/a-2099-1847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Vertebral bodies are one of the most common metastasis sites found in advanced prostate cancer and have a significant impact on patients' quality of life. Spinal metastases frequently cause severe back pain and in some occasions can lead to secondary complications, with serious neurological deficits and loss of function. The main treatment goals include adequate pain management, controlling tumour growth and restoring spinal stability. Publications on the role of surgery - both conventional and stereotactic radiotherapy, and either as an individual modality or in combination - have been inconclusive. The NOMS score has proven to be useful in making treatment decisions. Existing data show better outcomes in patients with surgical therapy, both when performed in isolation and also combined with radiotherapy, in which some of the cohorts studied including patients with primary cancer other than prostate cancer. Comparative studies that specifically investigate the superiority of specific therapy modalities for metastatic prostate carcinoma are scarce. Similarly, there are limited data on microsurgical interventions for spinal metastases. Radiotherapy alone is crucial in the setting of palliation, especially for pain relief, and its effectiveness has been shown in many studies. The patient's life expectancy plays a crucial role in deciding the most appropriate treatment approach. Given the complexity of the patient population, a multimodal therapy approach is necessary. Current trends in therapy favour greater use of surgical interventions, particularly in the early detection of spinal metastases.
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Affiliation(s)
- Lidija Ujkic
- Klinik für Orthopädie, Unfallchirurgie und plastisch-ästhetische Chirurgie, Uniklinik Köln, Köln, Germany
| | - Ricardo Sutanto
- Klinik für Radioonkologie, Cyberknife und Strahlentherapie, Uniklinik Köln, Köln, Germany
| | - Peter Knöll
- Klinik für Orthopädie, Unfallchirurgie und plastisch-ästhetische Chirurgie, Uniklinik Köln, Köln, Germany
| | - Kourosh Zarghooni
- Klinik für Orthopädie und Unfallchirurgie, HELIOS Klinikum Hildesheim, Hildesheim, Germany
| | - Johannes Rosenbrock
- Klinik für Radioonkologie, Cyberknife und Strahlentherapie, Uniklinik Köln, Köln, Germany
| | - Sebastian Walter
- Klinik für Orthopädie, Unfallchirurgie und plastisch-ästhetische Chirurgie, Uniklinik Köln, Köln, Germany
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Chaliparambil RK, Krushelnytskyy M, Shlobin NA, Thirunavu V, Roumeliotis AG, Larkin C, Kemeny H, El Tecle N, Koski T, Dahdaleh NS. Surgical management of spinal metastases from primary thyroid carcinoma: Demographics, clinical characteristics, and treatment outcomes - A retrospective analysis. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2024; 15:92-98. [PMID: 38644915 PMCID: PMC11029107 DOI: 10.4103/jcvjs.jcvjs_7_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 01/29/2024] [Indexed: 04/23/2024] Open
Abstract
Objective Metastatic spinal tumors represent a rare but concerning complication of primary thyroid carcinoma. We identified demographics, metastatic features, outcomes, and treatment strategies for these tumors in our institutional cohort. Materials and Methods We retrospectively reviewed patients surgically treated for spinal metastases of primary thyroid carcinoma. Demographics, tumor characteristics, and treatment modalities were collected. The functional outcomes were quantified using Nurik, Modified Rankin, and Karnofsky Scores. Results Twelve patients were identified who underwent 17 surgeries for resection of spinal metastases. The primary thyroid tumor pathologies included papillary (4/12), follicular (6/12), and Hurthle cell (2/12) subtypes. The average number of spinal metastases was 2.5. Of the primary tumor subtypes, follicular tumors averaged 2.8 metastases at the highest and Hurthle cell tumors averaged 2.0 spinal metastases at the lowest. Five patients (41.7%) underwent preoperative embolization for their spinal metastases. Seven patients (58.3%) received postoperative radiation. There was no significant difference in progression-free survival between patients receiving surgery with adjuvant radiation and surgery alone (P = 0.0773). Five patients (41.7%) experienced postoperative complications. Two patients (16.7%) succumbed to disease progression and two patients (16.7%) experienced tumor recurrence following resection. Postsurgical mean Nurik scores decreased 0.54 points, mean Modified Rankin scores decreased 0.48 points, and mean Karnofsky scores increased 4.8 points. Conclusion Surgery presents as an important treatment modality in the management of spinal metastases from thyroid cancer. Further work is needed to understand the predictive factors for survival and outcomes following treatment.
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Affiliation(s)
| | - Mykhaylo Krushelnytskyy
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nathan A. Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Vineeth Thirunavu
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Anastasios G. Roumeliotis
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Collin Larkin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Hanna Kemeny
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Najib El Tecle
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Tyler Koski
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nader S. Dahdaleh
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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4
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Lee CC, Tey J, Cheo T, Lee CH, Wong A, Kumar N, Vellayappan B. Outcomes of Patients With Spinal Metastases From Prostate Cancer Treated With Conventionally-Fractionated External Beam Radiation Therapy. Global Spine J 2023; 13:284-294. [PMID: 33648366 PMCID: PMC9972278 DOI: 10.1177/2192568221994798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To evaluate the outcomes of conventionally-fractionated external beam radiation therapy (cEBRT) in the treatment of prostate cancer spinal metastases (PCSM). METHODS Patients who received palliative cEBRT for PCSM in our institution between 2008 and 2018 were included. Our outcomes were local progression-free survival (LPFS), overall survival (OS), pain response and toxicities graded using CTCAE version 4.03. Univariable and multivariable Cox proportional hazard regressions were performed to identify predictors for LPFS and OS. RESULTS A total of 100 patients with 132 sites of PCSM were identified, with a median follow-up of 54 months. Fourteen-percent of patients underwent surgical intervention before receiving cEBRT. Eighteen spinal segments (13.6%) had local progression, with a median time to local progression of 8 months. The median LPFS and OS were 7.8 and 9.0 months, respectively. The complete and partial pain response rates were 57% and 39% respectively. The incidence of grade ≥3 acute toxicities was 11%. Better ECOG performance status (0 to 1), castration-sensitive disease, spinal surgery and use of novel antiandrogen agent were identified as significant predictors for improved OS on multivariable analysis. CONCLUSIONS In our prostate cancer cohort, cEBRT is an effective treatment modality for local palliation of spinal metastases. More aggressive treatment approach should be considered for patients with excellent performance status and castration-sensitive disease in light of their expected longer survival. Further studies are warranted to identify the predictors for radiotherapy response in this population.
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Affiliation(s)
- Chia Ching Lee
- Department of Radiation Oncology,
National University Cancer Institute, National University Hospital, National
University Health System, National University of Singapore, Singapore,
Singapore
| | - Jeremy Tey
- Department of Radiation Oncology,
National University Cancer Institute, National University Hospital, National
University Health System, National University of Singapore, Singapore,
Singapore
| | - Timothy Cheo
- Department of Radiation Oncology,
National University Cancer Institute, National University Hospital, National
University Health System, National University of Singapore, Singapore,
Singapore
| | - Chau Hung Lee
- Department of Radiology, Tan Tock Seng
Hospital, Singapore, Singapore
| | - Alvin Wong
- Department of Haematology-Oncology,
National University Cancer Institute, National University Hospital, Singapore
| | - Naresh Kumar
- Department of Orthopaedic Surgery,
National University Hospital, National University Health System, National University
of Singapore, Singapore
| | - Balamurugan Vellayappan
- Department of Radiation Oncology,
National University Cancer Institute, National University Hospital, National
University Health System, National University of Singapore, Singapore,
Singapore
- Balamurugan Vellayappan, Department of
Radiation Oncology, National University Cancer Institute, National University
Hospital, National University Health System, National University of Singapore,
1E Kent Ridge Road, NUHS Tower Block, Level 7, 119228 Singapore, Singapore.
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Moura MFAD, Nakagawa SA, Sanches DP, Vianna KCM. Axial Axis Metastasis. Rev Bras Ortop 2023; 58:9-18. [PMID: 36969783 PMCID: PMC10038728 DOI: 10.1055/s-0042-1756158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 06/14/2022] [Indexed: 03/26/2023] Open
Abstract
Axial axis metastasis remains a challenge for surgical as well as other treatment modalities, like chemotherapy, immunotherapy, and radiotherapy. It is unequivocal that surgery provides pain improvements and preservation of neurological status, but this condition remains when associated with radiotherapy and other treatment modalities. In this review, we emphasize the current forms of surgical treatment in the different regions of the spine and pelvis. The evident possibility of percutaneous treatments is related to early or late cases, and in cases in which there are greater risks and instability to conventional surgeries associated with radiotherapy and have been shown to be the appropriate option for local control of metastatic disease.
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Affiliation(s)
- Marcio Fernando Aparecido de Moura
- Ortopedia Oncológica e Cirurgia da Coluna Vertebral, Hospital de Clínicas e Hospital do Trabalhador da Universidade Federal do Paraná, Curitiba, PR, Brasil
- Departamento de Cirurgia da Universidade Federal do Paraná (UFPR) Curitiba, PR, Brasil
| | | | - Diego Pereira Sanches
- Ortopedia Oncológica do Hospital do Trabalhador da Universidade Federal do Paraná, Curitiba, PR, Brasil
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Lange N, Stadtmüller T, Scheibel S, Reischer G, Wagner A, Meyer B, Gempt J. Analysis of risk factors for perioperative complications in spine surgery. Sci Rep 2022; 12:14350. [PMID: 35999446 PMCID: PMC9399240 DOI: 10.1038/s41598-022-18417-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 08/10/2022] [Indexed: 11/09/2022] Open
Abstract
Complications in spine surgery can arise in the intraoperative or the immediate postoperative period or in a delayed manner. These complications may lead to severe or even permanent morbidity if left undiagnosed and untreated. We prospectively interviewed 526 patients out of 1140 patients who consecutively underwent spinal surgery in our department between November 2017 and November 2018 and analysed the outcome and complication rates. A 12 months follow-up period was also adopted. We analysed the patients' clinical characteristics, comorbidities, surgical management, survival rates, and outcomes. Risk factor analyses for the development of complications were also performed. Patients' median age was 67 years (range: 13-96). The main diagnoses were as follows: degenerative in 50%, tumour in 22%, traumatic fractures in 13%, infections in 10%, reoperations in 3%, and others in 2%. Surgeries were emergency procedures (within 24 h) in 12%. Furthermore, 59% required instrumentation. The overall postoperative complication rate was 26%. Revision surgery was required in 12% of cases within 30 postoperative days (median time to revision 11 days [IQR 5-15 days]). The most frequent complications included wound healing disorders, re-bleeding, and CSF leakage. Thereby, the risk factor analysis revealed age-adjusted CCI (p = 0.01), metastatic tumour (p = 0.01), and atrial fibrillation (p = 0.02) as significant risk factors for postoperative complications. Additionally, postoperative KPS (p = 0.004), postoperative anaemia (p = 0.001), the length of hospital stay (p = 0.02), and duration of surgery (p = 00.002) were also identified as associated factors. Complication rates after spinal surgeries are still high, especially in patients with metastatic tumour disease and poor clinical status (KPS), requiring revision surgeries in several cases. Therefore, specific risk factors should be determined to carefully select surgery groups.
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Affiliation(s)
- Nicole Lange
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Ismaningerstraße 22, 81675, Munich, Germany.
| | - Thomas Stadtmüller
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Ismaningerstraße 22, 81675, Munich, Germany
| | - Stefanie Scheibel
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Ismaningerstraße 22, 81675, Munich, Germany
| | - Gerda Reischer
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Ismaningerstraße 22, 81675, Munich, Germany
| | - Arthur Wagner
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Ismaningerstraße 22, 81675, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Ismaningerstraße 22, 81675, Munich, Germany
| | - Jens Gempt
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Ismaningerstraße 22, 81675, Munich, Germany
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Tabourel G, Terrier LM, Dubory A, Cristini J, Nail LRL, Cook AR, Buffenoir K, Pascal-Moussellard H, Carpentier A, Mathon B, Amelot A. Are spine metastasis survival scoring systems outdated and do they underestimate life expectancy? Caution in surgical recommendation guidance. J Neurosurg Spine 2021; 35:527-534. [PMID: 34298515 DOI: 10.3171/2020.12.spine201741] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 12/02/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Survival scoring systems for spine metastasis (SPM) were designed to help surgical practice. The authors sought to validate the prognostic accuracy of the main preoperative scoring systems for SPM. METHODS It was hypothesized that true patient survival in SPM was better than that predicted using prognosis scores. To investigate this hypothesis, the authors designed a French national retrospective study of a prospectively collected multicenter database involving 739 patients treated for SPM between 2014 and 2017. RESULTS In this series, the median survival time for all patients from an SPM diagnosis was 17.03 ± 1.5 months. Sensitivity and specificity were estimated using the area under the curve (AUC). The AUC of Tomita's prognosis score was the lowest and poorest (0.4 ± 0.023, range 0.35-0.44), whereas the AUC of the Tokuhashi score was the highest (0.825). The Lei score presented an AUC of 0.686 ± 0.022 (range 0.64-0.7), and the Rades score showed a weaker AUC (0.583 ± 0.020, range 0.54-0.63). Differences among AUCs were all statistically significant (p < 0.001). The modified Bauer score and the Rades score had the highest rate of agreement in predicting survival, with a weighted Cohen's kappa of 0.54 and 0.41, respectively, indicating a moderate agreement. The revised Tokuhashi and Lei scores had a fair rate of agreement (weighted Cohen's kappa = 0.24 and 0.22, respectively). The van der Linden and Tomita scores demonstrated the worst performance, with only a "slight" rate of agreement (weighted Cohen's kappa = 0.19 and 0.16, respectively) between what was predicted and the actual survival. CONCLUSIONS The use of prognostic scoring systems in the estimation of survival in patients with SPM has become obsolete and therefore underestimates survival. Surgical treatment decisions should no longer be based on survival estimations alone but must also take into account patient symptoms, spinal instability, and quality of life.
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Affiliation(s)
- Gaston Tabourel
- 1Department of Neurosurgery, Bretonneau Hospital, Tours
- 2Department of Neurosurgey/Neurotraumatology, Hôtel-Dieu Hospital, Nantes
| | | | - Arnaud Dubory
- 3Department of Orthopedic Surgery, Mondor Hospital-APHP, Créteil
| | - Joseph Cristini
- 2Department of Neurosurgey/Neurotraumatology, Hôtel-Dieu Hospital, Nantes
| | | | - Ann-Rose Cook
- 1Department of Neurosurgery, Bretonneau Hospital, Tours
| | - Kévin Buffenoir
- 2Department of Neurosurgey/Neurotraumatology, Hôtel-Dieu Hospital, Nantes
| | | | | | - Bertrand Mathon
- 6Neurosurgery, La Pitié-Salpêtrière Hospital-APHP, Paris, France
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Predictive Value of the Spinal Instability Neoplastic Score for Survival and Ambulatory Function After Surgery for Metastatic Spinal Cord Compression in 110 Patients with Prostate Cancer. Spine (Phila Pa 1976) 2021; 46:550-558. [PMID: 33273445 DOI: 10.1097/brs.0000000000003835] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN We retrospectively analyzed Spinal Instability Neoplastic Score (SINS) in 110 patients with prostate cancer operated for metastatic spinal cord compression (MSCC). OBJECTIVE We aimed to investigate the association between SINS and clinical outcomes after surgery for MSCC in patients with prostate cancer. SUMMARY OF BACKGROUND DATA The SINS is a useful tool for assessing tumor-related spinal instability, but its prognostic value regarding survival and neurological outcome is still controversial. METHODS We analyzed 110 consecutive patients with prostate cancer who underwent surgery for MSCC. The patients were categorized according to their SINS. Patients with castration-resistant prostate cancer (CRPC, n = 84) and those with hormone-naïve disease (n = 26) were analyzed separately. RESULTS In total, 106 of 110 patients met the SINS criteria for potential instability or instability (scores 7-18). The median SINS was 10 (range 6-15) for patients with CRPC and 9 (7-16) for hormone-naïve patients. In the CRPC group, the SINS was classified as stable (score 0-6) in 4 patients, as potentially unstable (score 7-12) in 70 patients, and as unstable (score 13-18) in 10 patients. In the hormone-naïve group, 22 patients met the SINS criteria for potential instability and 4 patients for instability. There was no statistically significant difference in the overall risk for death between the SINS potentially unstable and unstable categories (adjusted hazard ratio 1.3, P = 0.4), or in the risk of loss of ambulation 1 month after surgery (adjusted odds ratio 1.4, P = 0.6). CONCLUSION The SINS is helpful in assessing spinal instability when selecting patients for surgery, but it does not predict survival or neurological outcomes. Patients with a potential spinal instability benefit equally from surgery for MSCC as do patients with spinal instability.Level of Evidence: 3.
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Wagner A, Haag E, Joerger AK, Jost P, Combs SE, Wostrack M, Gempt J, Meyer B. Comprehensive surgical treatment strategy for spinal metastases. Sci Rep 2021; 11:7988. [PMID: 33846484 PMCID: PMC8042046 DOI: 10.1038/s41598-021-87121-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 03/24/2021] [Indexed: 12/31/2022] Open
Abstract
The management of patients with spinal metastases (SM) requires a multidisciplinary team of specialists involved in oncological care. Surgical management has evolved significantly over the recent years, which warrants reevaluation of its role in the oncological treatment concept. Any patient with a SM was screened for study inclusion. We report baseline characteristics, surgical procedures, complication rates, functional status and outcome of a large consecutive cohort undergoing surgical treatment according to an algorithm. 667 patients underwent 989 surgeries with a mean age of 65 years (min/max 20–94) between 2007 and 2018. The primary cancers mostly originated from the prostate (21.7%), breast (15.9%) and lung (10.0%). Surgical treatment consisted of dorsoventral stabilization in 69.5%, decompression without instrumentation in 12.5% and kyphoplasty in 18.0%. Overall survival reached 18.4 months (95% CI 9.8–26.9) and the median KPS increased by 10 within hospital stay. Surgical management of SMs should generally represent the first step of a conclusive treatment algorithm. The need to preserve long-term symptom control and biomechanical stability requires a surgical strategy currently not supported by level I evidence.
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Affiliation(s)
- Arthur Wagner
- Department of Neurosurgery, Klinikum Rechts Der Isar, Technical University Munich School of Medicine, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Elena Haag
- Department of Neurosurgery, Klinikum Rechts Der Isar, Technical University Munich School of Medicine, Ismaninger Str. 22, 81675, Munich, Germany
| | - Ann-Kathrin Joerger
- Department of Neurosurgery, Klinikum Rechts Der Isar, Technical University Munich School of Medicine, Ismaninger Str. 22, 81675, Munich, Germany
| | - Philipp Jost
- Department of Hematology and Oncology, Technical University Munich School of Medicine, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Technical University Munich School of Medicine, Munich, Germany
| | - Maria Wostrack
- Department of Neurosurgery, Klinikum Rechts Der Isar, Technical University Munich School of Medicine, Ismaninger Str. 22, 81675, Munich, Germany
| | - Jens Gempt
- Department of Neurosurgery, Klinikum Rechts Der Isar, Technical University Munich School of Medicine, Ismaninger Str. 22, 81675, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum Rechts Der Isar, Technical University Munich School of Medicine, Ismaninger Str. 22, 81675, Munich, Germany
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10
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A Novel Nomogram for Survival Prediction of Patients with Spinal Metastasis From Prostate Cancer. Spine (Phila Pa 1976) 2021; 46:E364-E373. [PMID: 33620180 DOI: 10.1097/brs.0000000000003888] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective study of 84 patients with spinal metastasis from prostate cancer (SMPCa) was performed. OBJECTIVE The aim of this study was to predict the survival of patients with SMPCa by establishing an effective prognostic nomogram model, associating with the affecting factors and compare its efficacy with the existing scoring models. SUMMARY OF BACKGROUND DATA Prostate cancer (PCa) is the second most frequently malignant cancer causing death in men, and the spine is the most common site of bone metastatic burden. The aim of this study was to establish a prognostic nomogram for survival prediction of patients with SMPCa, explore associated factors, and compare the effectiveness of the new nomogram prediction model with the existing scoring systems. METHODS Included in this study were 84 SMPCa patients who were admitted in our spinal tumor center between 2006 and 2018. Their clinical data were retrospectively analyzed by univariate and multivariate analyses to identify independent variables that enabled to predict prognosis. A nomogram, named Changzheng Nomogram for Survival Prediction (CNSP), was established on the basis of preoperative independent variables, and then subjected to bootstrap re-samples for internal validation. The predictive accuracy and discriminative ability were measured by concordance index (C-index). Receiver-operating characteristic (ROC) analysis with the corresponding area under the ROC was used to estimate the prediction efficacy of CNSP and compare it with the four existing prognostic models Tomita, Tokuhashi, Bauer, and Crnalic. RESULTS A total of seven independent variables including Gleason score (P = 0.001), hormone refractory (P < 0.001), visceral metastasis (P < 0.001), lymphocyte to monocyte ratio (P = 0.009), prostate-specific antigen (P = 0.018), fPSA/tPSA (P = 0.029), Karnofsky Performance Status (P = 0.039) were identified after accurate analysis, and then entered the nomogram with the C-index of 0.87 (95% confidence interval, 0.84-0.90). The calibration curves for probability of 12-, 24-, and 36-month overall survival (OS) showed good consistency between the predictive risk and the actual risk. Compared with the previous prognostic models, the CNSP model was significantly more effective than the four existing prognostic models in predicting OS of the SMPCa patients (p < 0.05). CONCLUSION The overall performance of the CNSP model was satisfactory and could be used to estimate the survival outcome of individual patients more precisely and thus help clinicians design more specific and individualized therapeutic regimens.Level of Evidence: 4.
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11
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Amelot A, Terrier LM, Le Nail LR, Cristini J, Cook AR, Buffenoir K, Pascal-Moussellard H, Carpentier A, Dubory A, Mathon B. Spine metastasis in patients with prostate cancer: Survival prognosis assessment. Prostate 2021; 81:91-101. [PMID: 33064325 DOI: 10.1002/pros.24084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 10/05/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Patients presenting spine metastasis (SpM) from prostate cancer (PC) form a heterogeneous population, through this study, we aimed to clarify and update their prognostic assessment. METHODS The patient data used in this study was obtained from a French national multicenter database of patients treated for PC with SpM between 2014 and 2017. A total of 72 patients and 365 SpM cases were diagnosed. RESULTS The median overall survival time for all patients following the event of SpM was 28.8 months. First, we identified three significant survival prognostic factors of PC patients with SpM: good Eastern Cooperative Oncology Group/World Health Organization personnel status (Status 0 hazard ratio [HR]: 0.031, 95% confidence interval [CI]: 0.008-0.127; p < .0001) or (Status 1 HR: 0.163, 95% CI: 0.068-0.393; p < .0001) and SpM radiotherapy (HR: 2.923, 95% CI: 1.059-8.069; p < .0001). Secondly, the presence of osteolytic lesions of the spine (vs. osteoblastic) was found to represent an independent prognosis factor for longer survival [HR: 0.424, 95% CI: 0.216-0.830; p = .01]. Other factors including the number of SpM, surgery, extraspinal metastasis, synchrone metastasis, metastasis-free survival, and SpM recurrence were not identified as being prognostically relevant to the survival of patients with PC. CONCLUSION Survival and our ability to estimate it in patients presenting PC with SpM have improved significantly. Therefore, we advocate the relevance of updating SpM prognostic scoring algorithms by incorporating data regarding the timeline of PC as well as the presence of osteolytic SpM to conceive treatments that are adapted to each patient.
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Affiliation(s)
- Aymeric Amelot
- Department of Neurosurgery, La Pitié Salpétrière Hospital-APHP, Paris, France
- Department of Neurosurgery, Bretonneau Hospital, Tours, France
| | | | | | - Joseph Cristini
- Department of Neurosurgery/Neurotraumatology, Hotel-Dieu Hospital, Nantes, France
| | - Ann-Rose Cook
- Department of Neurosurgery, Bretonneau Hospital, Tours, France
| | - Kévin Buffenoir
- Department of Neurosurgery/Neurotraumatology, Hotel-Dieu Hospital, Nantes, France
| | | | | | - Arnaud Dubory
- Department of Orthopaedic Surgery, Mondor Hospital-APHP, Créteil, France
| | - Bertrand Mathon
- Department of Neurosurgery, La Pitié Salpétrière Hospital-APHP, Paris, France
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12
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Owari T, Miyake M, Nakai Y, Tanaka N, Itami Y, Hirao S, Momose H, Nakagawa Y, Iida K, Maesaka F, Shimizu T, Iemura Y, Matsumoto Y, Kuwada M, Otani T, Otsuka K, Okajima E, Hosokawa Y, Okamura R, Fujimoto K. External validation of a genitourinary cancer-specific prognostic scoring system to predict survival for patients with bone metastasis (modified B-FOM scoring model): Comparison with other scoring models in terms of accuracy. J Bone Oncol 2020; 26:100344. [PMID: 33384916 PMCID: PMC7770480 DOI: 10.1016/j.jbo.2020.100344] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/27/2020] [Accepted: 11/28/2020] [Indexed: 12/29/2022] Open
Abstract
Bone is one of major metastatic site in patients with genitourinary (GU) cancer. Accurately predicting survival of patients with bone metastasis (BM) is essential. This external validation study proved high predictive accuracy of B-FOM score. B-FOM score is a simple scoring model based on five prognostic factors. B-FOM score is higher accurate tool comparing to other previously reported scores.
Objective We previously developed genitourinary (GU) cancer-specific scoring system for prediction of survival in patients with bone metastasis (the Bone-Fujimoto-Owari-Miyake [B-FOM] scoring model) based on five prognostic factors: the type of primary tumor (prostate cancer (PCa) vs renal cell carcinoma (RCC) and PCa vs urothelial carcinoma (UC)), poor performance status (PS), visceral metastasis, high Glasgow-prognostic score (GPS), elevated neutrophil-to-lymphocyte ratio (NLR). The aim of this study was to externally validate and further improve the performance of the B-FOM score. Methods The external validation cohort comprised 309 patients with GU cancer with bone metastasis from multiple institutions. Clinical factors were analyzed using Kaplan-Meier method and COX regression hazard model. Performance of a modified B-FOM score was compared to that of other scoring models by the Kaplan-Meier method and the area under the curve (AUC) of receiver operating characteristic curves. Results The median follow-up period of development and validation cohort were 25 and 17 months, respectively. Kaplan-Meier curve demonstrated that the type of primary tumor (RCC and UC vs PCa), poor PS, presence of visceral metastasis, high GPS, elevated NLR were significantly associated with shorter cancer-specific survival. Risk groups were successfully stratified by the modified B-FOM score classification. Moreover, the AUC of the modified B-FOM scoring model for predicting mortality at 6, 12, and 24 months were 0.895, 0.856, and 0.815, respectively, which were the highest among evaluated models. Conclusions The B-FOM scoring model is a simple and accurate prediction tool. By using this scoring model at the time of the diagnosis of bone metastasis in patients with GU cancers, an individualized optimal treatment strategy can be selected.
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Affiliation(s)
- Takuya Owari
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Nobumichi Tanaka
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | | | | | | | | | - Kouta Iida
- Yamatotakada Municipal Hospital, Yamatotakada, Nara, Japan
| | - Fumisato Maesaka
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Takuto Shimizu
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Yusuke Iemura
- Nara Prefecture General Medical Center, Nara, Nara, Japan
| | | | | | | | | | | | | | | | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
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13
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He X, Jiao YQ, Yang XG, Hu YC. A Novel Prediction Tool for Overall Survival of Patients Living with Spinal Metastatic Disease. World Neurosurg 2020; 144:e824-e836. [PMID: 32956891 DOI: 10.1016/j.wneu.2020.09.081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To identify the significant prognostic factors for overall survival in patients with spinal metastases and to establish an online widget for predicting survival with an interactive visual approach. METHODS Patients operated for spinal metastases between 2010 and 2018 were retrospectively enrolled and were randomly divided into training and validation samples with a ratio of 7:3. Patients' characteristics were analyzed with univariate and multivariate Cox analyses to identify independent prognostic factors basing on the training sample. A shiny web tool was developed by transforming the fitted multivariable Cox model into a visual interface. Time-dependent area under the curve plot and calibration curve were generated to assess the discrimination ability and consistency of the novel model, both for the training and validation samples. RESULTS A total of 265 consecutive patients were finally included, with 185 in the training sample and 80 in the validation sample. The primary tumor types, lesion site of metastasis, visceral metastasis, Frankel grade, operation category, number of surgical segments, and the preoperative percentage of lymphocyte were demonstrated to be significantly associated with overall survival. A novel shiny model (https://yang1209xg.shinyapps.io/predictspinalmetastasis/) that could provide predicted survival curve and median survival time was established, with favorable discrimination ability and consistency between predicted and actual survival both in internal and external data, according to time-dependent area under the curve plots and calibration curves. CONCLUSIONS A user-friendly shiny app with favorable discrimination ability and consistency was released online for predicting the survival of patients with spinal metastases. A continuous survival curve and the predicted median survival time are available to guide the treatment planning.
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Affiliation(s)
- Xin He
- Department of Bone Oncology, Tianjin Hospital, Tianjin, China
| | | | - Xiong-Gang Yang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Yong-Cheng Hu
- Department of Bone Oncology, Tianjin Hospital, Tianjin, China.
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14
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Scoring Algorithms for Predicting Survival Prognosis in Patients With Metastatic Spinal Disease: The Current Status and Future Directions. Clin Spine Surg 2020; 33:296-306. [PMID: 32604194 DOI: 10.1097/bsd.0000000000001031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Various survival scoring systems have been developed to help surgeons select the best candidates for appropriate therapies in patients with metastatic spinal disease. This study aims to discuss the current status and future directions of scoring systems for the prediction of survival prognosis in these patients. The search terms "spine metastases," "metastatic spinal disease," and "metastatic spinal cord compression" were combined with "survival prognosis," "scoring system," and "score" to elicit relevant literatures in PubMed and Embase databases. As a result, 159 articles were selected from PubMed, and 246 articles were extracted from Embase. After reviewing each article, we carefully included and analyzed 74 articles about the development and evaluation of scoring systems for predicting survival prognosis in spine metastases. In this review, those scoring systems were stratified into the historic scoring systems and the modern scoring systems on the basis of the proposed time. The historic scoring systems, including the original/revised Tokuhashi scoring system, the Bauer scoring system, the Tomita scoring system, and the Linden scoring system, and the modern scoring systems, such as the Lei scoring system, the Bartels scoring system, the Mizumoto scoring system, the Bollen scoring system, the Rades scoring system, Oswestry Spinal Risk Index, and the Choi risk calculator, were introduced and discussed in this review. Besides, the clinical effectiveness and pitfalls of the existing systems and the future directions of the next generation of scoring systems were also addressed and discussed. We recommended these scoring systems as preferable reference tools to help doctors to select surgical candidates. In patients with long-term life expectancy, radical surgery, such as wide or marginal excision, can be considered in patients with neurological deficits, spine instability, or severe back pain. Besides, with the advancement and improvement of medical technologies, surgical procedures are changing, which can affect surgical indications such as vertebroplasty, minimal invasive surgery, and percutaneous stabilization, which can also be used in patients with spine instability or severe back pain, and do not require much recovery; hence, they can even be used in patients with relative short-term life expectancy. However, the decision about the treatment of patients with metastatic spinal disease is so complicated and should never rely on prognostic scores alone. The final therapeutic decision should be made by interdisciplinary corporations of oncologists, radiologists, and spinal surgeons. Besides, individual intentions should be respected.
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15
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Phinyo P, Boonyanaruthee C, Paholpak P, Pruksakorn D, Phanphaisarn A, Sangsin A. Natural disease progression and novel survival prediction model for hepatocellular carcinoma with spinal metastases: a 10-year single-center study. World J Surg Oncol 2020; 18:135. [PMID: 32563268 PMCID: PMC7306143 DOI: 10.1186/s12957-020-01913-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/12/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Individual prediction of life expectancy in patients with spinal metastases from hepatocellular carcinoma (HCC) is key for optimal treatment selection, especially when identifying potential candidates for surgery. Most reported prognostic tools provide categorical predictions, and only a few include HCC-related factors. This study aimed to investigate the natural progression of the disease and develop a prognostic tool that is capable of providing individualized predictions. METHODS Patients with HCC-derived metastatic spinal disease were identified from a retrospective cohort of patients with spinal metastases who were diagnosed at Chiang Mai University Hospital between 2006 and 2015. Kaplain-Meier methods and log-rank tests were used to statistically evaluate potential factors. Significant predictors from the univariable analysis were included in the flexible parametric survival regression for the development of a prognostic prediction model. RESULTS Of the 1143 patients diagnosed with HCC, 69 (6%) had spinal metastases. The median survival time of patients with HCC after spinal metastases was 79 days. In the multivariable analysis, a total of 11 potential clinical predictors were included. After backward elimination, four final predictors remained: patients aged > 60 years, Karnofsky Performance Status, total bilirubin level, and multifocality of HCC. The model showed an acceptable discrimination at C-statistics 0.73 (95% confidence interval 0.68-0.79) and fair calibration. CONCLUSION Four clinical parameters were used in the development of the individual survival prediction model for patients with HCC-derived spinal metastases of Chiang Mai University or HCC-SM CMU model. Prospective external validation studies in a larger population are required prior to the clinical implication of the model.
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Affiliation(s)
- Phichayut Phinyo
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Permsak Paholpak
- Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Dumneoensun Pruksakorn
- Department of Orthopedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Musculoskeletal Science and Translational Research, Chiang Mai University, Chiang Mai, Thailand
| | - Areerak Phanphaisarn
- Department of Orthopedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Musculoskeletal Science and Translational Research, Chiang Mai University, Chiang Mai, Thailand
| | - Apiruk Sangsin
- Department of Orthopedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Musculoskeletal Science and Translational Research, Chiang Mai University, Chiang Mai, Thailand
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16
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Gao ZY, Zhang T, Zhang H, Pang CG, Jiang WX. Prognostic factors for overall survival in patients with spinal metastasis secondary to prostate cancer: a systematic review and meta-analysis. BMC Musculoskelet Disord 2020; 21:388. [PMID: 32552816 PMCID: PMC7298793 DOI: 10.1186/s12891-020-03412-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/08/2020] [Indexed: 11/21/2022] Open
Abstract
Background To guide the selection of treatments for spinal metastases, the expected survival time is one of the most important determinants. Few scoring systems are fully applicable for spinal metastasis secondary to prostate cancer (PCa). This study aimed to identify the independent factors to predict the overall survival (OS) of patients with spinal metastases from PCa. Methods The PubMed, Embase and CENTRAL were retrieved by two reviewers independently, to identify studies analyzed the prognostic effect of different factors in spinal metastasis from PCa. A systematic review and quantitative meta-analysis was conducted with hazard ratio (HR) and 95% confidence interval (95%CI) as the effect size. Results A total of 12 retrospective cohort studies (1566 patients) were eligible for qualitative synthesis and 10 for quantitative meta-analyses. The OS was significantly influenced by performance status, visceral metastasis, ambulatory status and time from PCa diagnosis in more than half of the available studies. The meta-analyses demonstrated that OS was significantly influenced by visceral metastasis (HR = 2.24, 95%CI:1.53–3.27, p < 0.001), pre-treatment ambulatory status (HR = 2.64, 95%CI:1.82–3.83, p < 0.001), KPS (HR = 4.45, 95%CI:2.01–9.85, p < 0.001), ECOG (HR = 2.96, 95%CI:2.02–4.35, p < 0.001), extraspinal bone metastasis (HR = 2.04, 95%CI:1.13–3.68, p = 0.018), time developing motor deficit (HR = 1.57, 95%CI:1.30–1.88, p < 0.001) and time from PCa diagnosis (HR = 1.37, 95%CI:1.17–1.59, p < 0.001). Conclusions Visceral metastasis, ambulatory status, extraspinal bone metastasis, performance status, time developing motor deficit and time interval from primary tumor diagnosis were significantly associated with the OS for spinal metastasis from PCa. When selecting the treatment modality, clinicians should fully consider the patients’ systematic status based on all potential prognostic factors. Level of evidence I Meta-analysis.
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Affiliation(s)
- Zhong-Yu Gao
- Department of Orthopedic Surgery, Tianjin First Central Hospital, 24 Fukang Rd, Nankai District, Tianjin, 300192, China
| | - Tao Zhang
- Department of Orthopedic Surgery, Tianjin First Central Hospital, 24 Fukang Rd, Nankai District, Tianjin, 300192, China
| | - Hui Zhang
- Department of Orthopedic Surgery, Tianjin First Central Hospital, 24 Fukang Rd, Nankai District, Tianjin, 300192, China
| | - Cheng-Gang Pang
- Graduate School, Tianjin Medical University, Tianjin, 300070, China
| | - Wen-Xue Jiang
- Department of Orthopedic Surgery, Tianjin First Central Hospital, 24 Fukang Rd, Nankai District, Tianjin, 300192, China.
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17
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Lun DX, Chen NW, Feng JT, Yang XG, Xu ZW, Li F, Hu YC. Visceral Metastasis: A Prognostic Factor of Survival in Patients with Spinal Metastases. Orthop Surg 2020; 12:552-560. [PMID: 32227458 PMCID: PMC7189062 DOI: 10.1111/os.12657] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/11/2020] [Accepted: 02/19/2020] [Indexed: 12/12/2022] Open
Abstract
Objective To characterize the visceral metastasis as a predictive tool for the survival of patients with spinal metastases through an exploratory meta‐analysis. Methods Two investigators independently searched PubMed and Embase databases for eligible studies from 2000–2016. The effect estimates for the hazard ratio (HR) or risk ratio (RR) and 95% confidence interval (CI) were collected and pooled with a random‐ or fixed‐effect model. Results In total, 18 eligible studies were retrieved with 5468 participants from nine countries. The overall pooled effect size for HR and RR was 1.50 and 3.79, respectively, which was proved to be statistically significant. In the subgroup of prostate cancer (PCa) and non‐small cell lung cancer (NSCLC), statistical significance and marginal statistical significance was presented for the pooled HR (HR = 1.76, 95% CI 1.35–2.29) and (RR = 1.56, 95% CI 0.99–2.48), respectively. However, in the subgroup of thyroid cancer, breast cancer, and renal cancer, statistical significance was not achieved (HR = 1.17, 95% CI 0.75–1.83, Z = 0.70, P = 0.486). The results did not show any evidence of publication bias. Conclusions This study demonstrated that visceral metastasis was a significant prognostic factor in patients with spinal metastases as a whole. Interestingly, the onset of visceral metastases differentially impacted the survival in different primary tumors. Therefore, the prognostic value of visceral metastasis might be related to the type of primary tumor.
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Affiliation(s)
- Deng-Xing Lun
- Department of Spine Surgery, Weifang People's Hospital, Weifang, China
| | - Nai-Wang Chen
- Department of Spine Surgery, Weifang People's Hospital, Weifang, China
| | - Jiang-Tao Feng
- Graduate School of Tianjin Medical University, Tianjin, China
| | - Xion-Gang Yang
- Graduate School of Tianjin Medical University, Tianjin, China
| | - Zhao-Wan Xu
- Department of Spine Surgery, Weifang People's Hospital, Weifang, China
| | - Feng Li
- Department of Spine Surgery, Weifang People's Hospital, Weifang, China
| | - Yong-Cheng Hu
- Department of Bone Oncology, Tianjin Hospital, Tianjin, China
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18
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Cai Z, Tang X, Yang R, Yan T, Guo W. Modified score based on revised Tokuhashi score is needed for the determination of surgical intervention in patients with lung cancer metastases to the spine. World J Surg Oncol 2019; 17:194. [PMID: 31739788 PMCID: PMC6862838 DOI: 10.1186/s12957-019-1738-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 10/30/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Revised Tokuhashi score (RTS) is no longer accurate to predict the survival of patients with lung cancer metastases to the spine. This study is to identify additional prognostic factors in those patients, develop a modified prognostic score based on RTS, and verify the accuracy of the score in prediction. METHODS Our study included patients with lung cancer metastases to the spine who underwent surgery for spine metastasis. Potential prognostic factors were analyzed. Points were allocated for prognostic factors obtained from survival analyses. A modified score was developed by including prognostic factors and their points to RTS. Accuracy of the modified score was evaluated by comparing the coincidence between predicted and observed survival. Kaplan-Meier analysis and Cox regression models were used. Predictive values of scores for 6-month survival were measured via receiver operating characteristic (ROC) curves. RESULTS Targeted therapy and tumor markers were additional independent prognostic factors. In the modified score, 2 and 1 points were allocated to the new evaluation factors. The points for factors based on RTS remained the same, and two prognostic groups were redefined. For group A patients who were predicted to live for less than 6 months, conservative procedures would be recommended. For group B patients who were predicted to live for 6 months or more, palliative surgery would be recommended. When comparing the modified score to RTS, the area under the receiver operating characteristic curve (AUCROC) and accuracy of score were improved. CONCLUSIONS The modified RTS has improved prognostic accuracy in patients with lung cancer metastases to the spine.
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Affiliation(s)
| | - Xiaodong Tang
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China.
| | - Rongli Yang
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Taiqiang Yan
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Wei Guo
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China.
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Chohan MO, Kahn S, Cederquist G, Reiner AS, Schwab J, Laufer I, Bilsky M. Surgical Decompression of High-Grade Spinal Cord Compression from Hormone Refractory Metastatic Prostate Cancer. Neurosurgery 2019; 82:670-677. [PMID: 28541420 DOI: 10.1093/neuros/nyx292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 05/01/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Spine and nonspine skeletal metastases occur in more than 80% of patients with prostate cancer. OBJECTIVE To examine the characteristics of the patient population undergoing surgery for the treatment of prostate cancer metastatic to the spine. METHODS A retrospective chart review was performed on all patients treated at our institution from June 1993 to August 2014 for surgical management of metastatic spine disease from prostate cancer. RESULTS During the study period, 139 patients with 157 surgical lesions underwent surgery for metastatic spine disease. Decompression for high-grade epidural spinal cord compression was required for 126 patients with 143 lesions. Preoperatively, 69% had a motor deficit and 21% were nonambulatory, with 32% due to motor weakness. At surgery, 87% of patients had hormone-refractory prostate cancer (HRPC) and 61% failed prior radiation. Median overall survival for HRPC patients was 6.6 mo (95% confidence interval [CI]: 5.6-8.6) while the median overall survival for hormone-sensitive patients was 16.3 mo (95% CI: 4.0-26.6). CONCLUSION The majority of patients undergoing surgery for prostate cancer metastases to the spine were refractory to hormone therapy, indicating that patients with hormone-sensitive prostate cancer are unlikely to develop symptomatic spinal cord compression or spinal instability. A significant number of HRPC patients presented with neurological deficits attributable to spinal cord compression. Vigilant monitoring for the development of signs and symptoms of epidural spinal cord compression and spinal instability in hormone-refractory patients is recommended. Surgical decision making may be affected by the much shorter postoperative survival for HRPC patients as compared to patients with hormone-sensitive cancer.
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Affiliation(s)
- Muhammad Omar Chohan
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sweena Kahn
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gustav Cederquist
- Joan and Sanford I. Weill Medical College of Cornell University, New York, New York
| | - Anne S Reiner
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joseph Schwab
- Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Ilya Laufer
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Joan and Sanford I. Weill Medical College of Cornell University, New York, New York
| | - Mark Bilsky
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Joan and Sanford I. Weill Medical College of Cornell University, New York, New York
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Establishment and validation of a novel survival prediction scoring algorithm for patients with non-small-cell lung cancer spinal metastasis. Int J Clin Oncol 2019; 24:1049-1060. [PMID: 31028506 DOI: 10.1007/s10147-019-01452-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 04/14/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND This study was to develop an algorithm capable of predicting the survival of patients with NSCLC spinal metastasis for individualized therapy. METHODS We identified 176 consecutive patients with NSCLC spinal metastasis between 2006 and 2017. Twenty-four features, including age, gender, smoking, KPS, paralysis, histological subtype, tumor stage, surgery, EGFR status, CEA, CA125, CA19-9, NSE, SCC, CYFRA21-1, calcium, AKP, albumin, the number of spinal, extra-spinal bone and visceral metastasis, time to metastasis, pathological fracture, and primary or secondary metastasis, were retrospectively analyzed. Features associated with survival in the multivariate analyses were included in a scoring model, which was prospectively validated in another 63 patients (NCT03363685). RESULTS The median follow-up period was 12.00 months (interquartile range 6.00-23.40 months). One hundred forty-seven patients died during follow-up, with a median survival of 13.6 months being observed. Multivariate analysis revealed that the following features were associated with survival: age, smoking, CA125, SCC, KPS, and EGFR status. A scoring system based on these features was created to stratify patients into low-risk (0-3), intermediate-risk (4-6) and high-risk (7-10) groups, whose estimated median survival times 29.10, 10.40 and 3.90 months, respectively. The Harrell's c-index was 0.72. Model validation supported this model's validity and reproducibility. CONCLUSIONS In patients with NSCLC spinal metastasis, survival was associated with age, smoking, CA125, SCC, KPS, and EGFR status. A validated scoring system based on these features was devised that can predict the survival times of those patients. This scoring system provides a basis for applying the NOMS framework and for facilitating individual treatment.
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Yang XG, Lun DX, Hu YC, Liu YH, Wang F, Feng JT, Hua KC, Yang L, Zhang H, Xu MY, Zhang HR. Prognostic effect of factors involved in revised Tokuhashi score system for patients with spinal metastases: a systematic review and Meta-analysis. BMC Cancer 2018; 18:1248. [PMID: 30545326 PMCID: PMC6293585 DOI: 10.1186/s12885-018-5139-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 11/27/2018] [Indexed: 12/14/2022] Open
Abstract
Background Cancer patients’ survival time has obviously improved, with the development of systemic treatment techniques. However, the probability of metastases to the vertebrae has also been increased which makes some adverse effects on patients’ quality of life. The prediction of survival plays a key role in choosing therapeutic modality, and Tokuhashi Score was established as one of the most commonly used predictive systems for spinal metastases. Thus, this study was conducted to identify the prognostic effect of factors involved in revised Tokuhashi Score (RTS). Methods Two investigators independently retrieved relevant literature on platforms of PubMed, Embase and Cochrane Library. We identified eligible studies through title/abstract and full-text perusing. Data was extracted including general information of studies, participants’ characteristics, therapeutic modality, overall survival and prognostic effect of factors. Hazard ratio (HR) for each factor was synthesized if available through fixed- or random-effect models as appropriate. Results A total of 63 eligible studies with 10,411 participants were identified. Overall, cases with thyroid cancer had the highest survival rate, while the ones with non-small cell lung cancer and hepatocellular carcinoma lived for the shorted survival time. Performance status, bone metastasis, number of involved vertebrae, visceral metastasis, primary tumor and neurological status were regarded as significant predictors in 71.4, 40.0, 18.2, 63.4, 73.1 and 44.7% of the involved studies respectively. Thirty-eight articles were included in meta-analysis, and prognostic effects of five factors (apart from primary tumor) were analyzed. Factors were all proved to be significant except comparisons between KPS (Karnofsky Performance Status) 10–40 VS. 50–70 and single VS. multiple spinal metastases. Conclusion All factors of RTS were significant on prognosis predicting and should be considered when choosing therapeutic modality for spinal metastases. What’s more, we believe that more accurate prognosis may be obtained after removal of the cut-offs for KPS 10–40 VS. 50–70 and single VS. multiple involved vertebrae. Electronic supplementary material The online version of this article (10.1186/s12885-018-5139-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xiong-Gang Yang
- Department of Bone Tumor of Tianjin Hospital, Tianjin, 300211, China
| | | | - Yong-Cheng Hu
- Department of Bone Tumor of Tianjin Hospital, Tianjin, 300211, China.
| | | | - Feng Wang
- Tianjin Medical university, Tianjin, 300070, China
| | | | - Kun-Chi Hua
- Tianjin Medical university, Tianjin, 300070, China
| | - Li Yang
- Tianjin Medical university, Tianjin, 300070, China
| | - Hao Zhang
- Tianjin Medical university, Tianjin, 300070, China
| | - Ming-You Xu
- Tianjin Medical university, Tianjin, 300070, China
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Cassidy JT, Baker JF, Lenehan B. The Role of Prognostic Scoring Systems in Assessing Surgical Candidacy for Patients With Vertebral Metastasis: A Narrative Review. Global Spine J 2018; 8:638-651. [PMID: 30202719 PMCID: PMC6125937 DOI: 10.1177/2192568217750125] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVES To review the relevant literature regarding scoring systems for vertebral metastases and quantify their role in contemporary orthopedic practice. METHODS A literature search of PubMed, Google Scholar, and Embase was performed on February 7, 2017. Eight scoring systems were selected for detailed review-7 of which were scores focused solely on patient prognosis (Tokuhashi, Tomita, Bauer, Oswestry Spinal Risk Index, Van der Linden, Rades, and Katagiri). The eighth system reviewed was the Spinal Instability Neoplastic Score, which examines for impending spinal instability in patients with vertebral metastases and represents a novel approach compared with hitherto scoring systems. RESULTS The Bauer and Oswestry Spinal Risk Index have the most accurate prognostic predictive ability, with the newer Oswestry Spinal Risk Index being favored by the contemporary literature as it demands less investigation and is therefore more readily accessible. There was a growing trend in studies designed to customize scoring systems for individual cancer pathological subtypes. The Spinal Instability Neoplastic Score shows good reliability for predicting instability among surgeons and oncologists. CONCLUSIONS The increased understanding of cancer pathology and subsequent development of customized treatments has led to prolonged survival. For patients with vertebral metastases, this affects surgical candidacy not only on the basis of prognosis but also provides prolonged opportunity for the development of spinal instability. Scoring systems have a useful guidance role in these deciding for/against surgical intervention, but in order to remain contemporary ongoing review, development, and revalidation is mandatory.
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Affiliation(s)
- John Tristan Cassidy
- University Hospital Limerick, Limerick, Ireland,John Tristan Cassidy, Department of Trauma & Orthopaedic Surgery, University Hospital Limerick, Limerick, Ireland.
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Yang XG, Han Y, Wang F, Liu YH, Hu YC, Lun DX, Feng JT, Hua KC, Yang L, Zhang H, Xu MY, Zhang HR. Is Ambulatory Status a Prognostic Factor of Survival in Patients with Spinal Metastases? An Exploratory Meta-analysis. Orthop Surg 2018; 10:173-180. [PMID: 30133148 DOI: 10.1111/os.12393] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 06/04/2018] [Indexed: 01/31/2023] Open
Abstract
This study was conducted to identify the influence of ambulatory status prior to treatment on survival of patients with spinal metastases. Two investigators independently retrieved relevant electronic literature in PubMed, Embase, and Cochrane Library databases, to identify eligible studies. Effect estimates for hazard risk (HR) were extracted and synthesized through fixed-effects or random-effects models as appropriate. A total of 17 eligible studies were identified, with an accumulated number of 3962 participants. HR from 14 studies regarding comparison between ambulatory versus non-ambulatory groups were pooled using a random-effects model, and statistical significance was presented for the pooled HR (HR = 1.96; 95% confidence interval [CI], 1.65-2.34). In subgroups of mixed primary tumor and lung cancer, ambulatory status was considered to be a significant prognostic factor (P < 0.05), while in the subgroup of prostate cancer it was not (HR = 1.72; 95% CI, 0.79-3.74). HR from 4 studies related to comparison between Frankel E versus Frankel C-D were pooled using a fixed-effects model, which revealed statistical significance (HR = 1.73; 95% CI, 1.27-2.36). Ambulatory status is a significant prognostic factor in patients with spinal metastases. However, in patients with primary prostate cancer, the prognostic effect of ambulatory status has not yet been confirmed to be significant.
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Affiliation(s)
| | - Yue Han
- Department of Spine Surgery, Tianjin Hospital, Tianjin, China
| | - Feng Wang
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Yong-Heng Liu
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Yong-Cheng Hu
- Department of Bone Tumor, Tianjin Hospital, Tianjin, China
| | - Deng-Xing Lun
- Department of Spine Surgery, Weifang People's Hospital, Shandong, China
| | - Jiang-Tao Feng
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Kun-Chi Hua
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Li Yang
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Hao Zhang
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Ming-You Xu
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Hao-Ran Zhang
- Graduate School, Tianjin Medical University, Tianjin, China
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Abstract
STUDY DESIGN This is a retrospective analysis. OBJECTIVE The aim of this study was to determine the epidemiology, survival, and prognostic factors for cholangiocarcinoma (CCA) with spinal metastasis. SUMMARY OF BACKGROUND DATA CCA is an epithelial cell malignancy of the bile duct, and a frequent site for its metastasis is the spine. Many areas of Asia are endemic for CCAs. To date, there is limited data on the epidemiology, natural history, and prognostic factors of CCA with spinal metastasis, which is crucial for better management and treatment of the disease. MATERIALS AND METHODS Patients diagnosed with CCA were recruited to our study, in order to identify cases with spinal metastasis. The survival rate was estimated by the Kaplan-Meier method. The univariate and multivariate analyses of tumor-specific and spinal metastatic factors were performed to identify the independent factors that affect survival. RESULTS From 2006 to 2015, 4585 CCA patients were identified and 182 of these patients had spinal metastasis. The overall median survival of patients with spinal metastasis was 88 days. Serum carcinoembryonic antigen <5 ng/mL, carbohydrate antigen 19-9 <39 U/mL, albumin ≥3.5 g/L, and Frankel score D-E were found to be independent factors that resulted in better survival in a multivariate Cox regression analysis. CCA resection or spinal surgery did not prolong the survival of patients with spinal metastasis. CONCLUSION Spinal surgery should be considered for CCA patients with spinal metastasis, who have a favorable prognosis, and are likely to live long enough to benefit from surgery. The aim is to palliate the symptoms and not as much to improve the survival.
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Tokuhashi Y, Uei H, Oshima M. Classification and scoring systems for metastatic spine tumors: a literature review. Spine Surg Relat Res 2017; 1:44-55. [PMID: 31440612 PMCID: PMC6698555 DOI: 10.22603/ssrr.1.2016-0021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 12/20/2016] [Indexed: 01/29/2023] Open
Abstract
Introduction Accurate evaluation of metastasis and life prognosis is essential for selecting a suitable therapeutic strategy for metastatic spine tumors owing to limitations in treatment options. For this purpose, various classification, evaluation, and scoring systems have been developed. Methods Classification, evaluation, and scoring systems for metastatic spine tumors reported to date were identified by performing a literature search on PubMed. We reviewed the most cited classifications and scorings before 2009, and all classifications and scorings reported after 2010 from the search results. Results Six classifications and 23 scorings were reviewed. The classification/evaluation methods are divided into 1) anatomical classification/evaluation methods, 2) evaluation methods for neurological symptoms/instability, and 3) scoring systems for predicting life expectancy. The first 2 were useful for the planning and evaluation of surgical indications. Scoring systems for life prognosis also permitted rough prediction of the outcomes and were useful for the selection of a suitable treatment. However, variation of the patient background, diversity of adopted prognostic factors, and the absence of scoring systems that could predict the outcome with an accuracy of 90% or higher introduced some limitations. Conclusion The identified classification, evaluation, and scoring systems have been generally useful for treatment strategies. However, we emphasize the necessity of multidisciplinary development and revision of classification and evaluation methods to adapt to the prolongation of survival associated with increased diversity and improvement of treatment options.
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Affiliation(s)
- Yasuaki Tokuhashi
- Department of Orthopedic Surgery, Nihon University School of Medicine, Japan
| | - Hiroshi Uei
- Department of Orthopedic Surgery, Nihon University School of Medicine, Japan
| | - Masashi Oshima
- Department of Orthopedic Surgery, Nihon University School of Medicine, Japan
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Wänman J, Grabowski P, Nyström H, Gustafsson P, Bergh A, Widmark A, Crnalic S. Metastatic spinal cord compression as the first sign of malignancy. Acta Orthop 2017; 88:457-462. [PMID: 28492105 PMCID: PMC5499341 DOI: 10.1080/17453674.2017.1319179] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Metastatic spinal cord compression (MSCC) as the initial manifestation of malignancy (IMM) limits the time for diagnostic workup; most often, treatment is required before the final primary tumor diagnosis. We evaluated neurological outcome, complications, survival, and the manner of diagnosing the primary tumor in patients who were operated for MSCC as the IMM. Patients and methods - Records of 69 consecutive patients (51 men) who underwent surgery for MSCC as the IMM were reviewed. The patients had no history of cancer when they presented with pain (n = 2) and/or neurological symptoms (n = 67). Results - The primary tumor was identified in 59 patients. In 10 patients, no specific diagnosis could be established, and they were therefore defined as having cancer of unknown primary tumor (CUP). At the end of the study, 16 patients were still alive (median follow-up 2.5 years). The overall survival time was 20 months. Patients with CUP had the shortest survival (3.5 months) whereas patients with prostate cancer (6 years) and myeloma (5 years) had the longest survival. 20 of the 39 patients who were non-ambulatory preoperatively regained walking ability, and 29 of the 30 ambulatory patients preoperatively retained their walking ability 1 month postoperatively. 15 of the 69 patients suffered from a total of 20 complications within 1 month postoperatively. Interpretation - Postoperative survival with MSCC as the IMM depends on the type of primary tumor. Surgery in these patients maintains and improves ambulatory function.
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Affiliation(s)
- Johan Wänman
- Departments of Surgical and Perioperative Sciences (Orthopedics), Umeå University, Umeå, Sweden.
| | - Pawel Grabowski
- Departments of Surgical and Perioperative Sciences (Orthopedics), Umeå University, Umeå, Sweden.
| | - Helena Nyström
- Departments of Community Medicine and Rehabilitation (Geriatrics), Umeå University, Umeå, Sweden.
| | - Patrik Gustafsson
- Departments of Surgical and Perioperative Sciences (Orthopedics), Umeå University, Umeå, Sweden.
| | - Anders Bergh
- Departments of Medical Biosciences (Pathology), Umeå University, Umeå, Sweden.
| | - Anders Widmark
- Departments of Radiation Sciences (Oncology), Umeå University, Umeå, Sweden
| | - Sead Crnalic
- Departments of Surgical and Perioperative Sciences (Orthopedics), Umeå University, Umeå, Sweden.;,Correspondence:
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Clarke MJ, Molina CA, Fourney DR, Fisher CG, Gokaslan ZL, Schmidt MH, Rhines LD, Fehlings MG, Laufer I, Patel SR, Rampersaud YR, Reynolds J, Chou D, Bettegowda C, Mendel E, Weber MH, Sciubba DM. Systematic Review of the Outcomes of Surgical Treatment of Prostate Metastases to the Spine. Global Spine J 2017; 7:460-468. [PMID: 28811991 PMCID: PMC5544163 DOI: 10.1177/2192568217710911] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVE Surgical decompression and reconstruction of symptomatic spinal metastases has improved the quality of life in cancer patients. However, most data has been collected on cohorts of patients with mixed tumor histopathology. We systematically reviewed the literature for prognostic factors specific to the surgical treatment of prostate metastases to the spine. METHODS A systemic review of the literature was conducted to answer the following questions: Question 1. Describe the survival and functional outcomes of surgery or vertebral augmentation for prostate metastases to the spine. Question 2. Determine whether overall tumor burden, Gleason score, preoperative functional markers, and hormonal naivety favor operative intervention. Question 3. Establish whether clinical outcomes vary with the evolution of operative techniques. RESULTS A total of 16 studies met the preset inclusion criteria. All included studies were retrospective series with a level of evidence of IV. Included studies consistently showed a large effect of hormone-naivety on overall survival. Additionally, studies consistently demonstrated an improvement in motor function and the ability to maintain/regain ambulation following surgery resulting in moderate strength of recommendation. All other parameters were of insufficient or low strength. CONCLUSIONS There is a dearth of literature regarding the surgical treatment of prostate metastases to the spine, which represents an opportunity for future research. Based on existing evidence, it appears that the surgical treatment of prostate metastases to the spine has consistently favorable results. While no consistent preoperative indicators favor nonoperative treatment, hormone-naivety and high Karnofsky performance scores have positive effects on survival and clinical outcomes.
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Affiliation(s)
- Michelle J. Clarke
- Mayo Clinic, Rochester, MN, USA,Michelle J. Clarke, Department of Neurologic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | | | | | - Charles G. Fisher
- University of British Columbia, Vancouver, British Columbia, Canada,Vancouver General Hospital, Vancouver, British Columbia, Canada,Vancouver Spine Surgery Institute, Vancouver, British Columbia, Canada
| | - Ziya L. Gokaslan
- Brown University, Providence, RI, USA,Rhode Island Hospital, Providence, RI, USA,The Miriam Hospital, Providence, RI, USA,Norman Prince Neurosciences Institute, Providence, RI, USA
| | | | | | - Michael G. Fehlings
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada,University of Toronto, Toronto, Ontario, Canada
| | - Ilya Laufer
- Weill Cornell Medical College, New York, NY, USA,Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Y. Raja Rampersaud
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | | | - Dean Chou
- University of California, San Francisco, CA, USA
| | | | - Ehud Mendel
- The Ohio State University Wexner Medical Center, Columbus, OH, USA,The James Cancer Hospital, Columbus, OH, USA
| | - Michael H. Weber
- McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
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Luksanapruksa P, Buchowski JM, Hotchkiss W, Tongsai S, Wilartratsami S, Chotivichit A. Prognostic factors in patients with spinal metastasis: a systematic review and meta-analysis. Spine J 2017; 17:689-708. [PMID: 27988342 DOI: 10.1016/j.spinee.2016.12.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 11/10/2016] [Accepted: 12/09/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Incidence of symptomatic spinal metastasis has increased owing to improvement in treatment of the disease. One of the key factors that influences decision-making is expected patient survival. To our knowledge, no systematic reviews or meta-analysis have been conducted that review independent prognostic factors in spinal metastases. PURPOSE This study aimed to determine independent prognostic factors that affect outcome in patients with metastatic spine disease. STUDY DESIGN This is a systematic literature review and meta-analysis of publications for prognostic factors in spinal metastatic disease. PATIENT SAMPLE Pooled patient results from cohort and observational studies. OUTCOME MEASUREMENT Meta-analysis for poor prognostic factors as determined by hazard ratio (HR) and 95% confidential interval (95% CI). METHODS We systematically searched relevant publications in PubMed and Embase. The following search terms were used: ("'spinal metastases'" OR "'vertebral metastases'" OR ""spinal metastasis" OR 'vertebral metastases') AND ('"prognostic factors"' OR "'survival'"). Inclusion criteria were prospective and retrospective cohort series that report HR and 95% CI of independent prognostic factors from multivariate analysis. Two reviewers independently assessed all papers. The quality of included papers was assessed by using Newcastle-Ottawa Scale for cohort studies and publication bias was assessed by using funnel plot, Begg test, and Egger test. The prognostic factors that were mentioned in at least three publications were pooled. Meta-analysis was performed using HR and 95% CI as the primary outcomes of interest. Heterogeneity was assessed using the I2 method. RESULTS A total of 3,959 abstracts (1,382 from PubMed and 2,577 from Embase) were identified through database search and 40 publications were identified through review of cited publications. The reviewers selected a total of 51 studies for qualitative synthesis and 43 studies for meta-analysis. Seventeen poor prognostic factors were identified. These included presence of a neurologic deficit before surgery, non-ambulatory status before radiotherapy (RT), non-ambulatory status before surgery, presence of bone metastases, presence of multiple bone metastases (>2 sites), presence of multiple spinal metastases (>3 sites), development of motor deficit in <7 days before initiating RT, development of motor deficit in <14 days before initiating RT, time interval from cancer diagnosis to RT <15 months, Karnofsky Performance Score (KPS) 10-40, KPS 50-70, KPS<70, Eastern Cooperative Oncology Group (ECOG) grade 3-4, male gender, presence of visceral metastases, moderate growth tumor on Tomita score (TS) classification, and rapid growth tumor on TS classification. CONCLUSIONS Seventeen independent poor prognostic factors were identified in this study. These can be categorized into cancer-specific and nonspecific prognostic factors. A tumor-based prognostic scoring system that combines all specific and general factors may enhance the accuracy of survival prediction in patients with metastatic spine disease.
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Affiliation(s)
- Panya Luksanapruksa
- Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd Bangkoknoi, Bangkok 10700, Thailand
| | - Jacob M Buchowski
- Department of Orthopedic Surgery, Barnes-Jewish Institute of Health, Washington University in St. Louis, 425 S. Euclid Ave, Campus Box 8233, St. Louis, MO 63110, USA.
| | - William Hotchkiss
- Department of Orthopedic Surgery, Barnes-Jewish Institute of Health, Washington University in St. Louis, 425 S. Euclid Ave, Campus Box 8233, St. Louis, MO 63110, USA
| | - Sasima Tongsai
- Office for Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road Bangkoknoi, Bangkok 10700, Thailand
| | - Sirichai Wilartratsami
- Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd Bangkoknoi, Bangkok 10700, Thailand
| | - Areesak Chotivichit
- Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd Bangkoknoi, Bangkok 10700, Thailand
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Yao A, Sarkiss CA, Ladner TR, Jenkins AL. Contemporary spinal oncology treatment paradigms and outcomes for metastatic tumors to the spine: A systematic review of breast, prostate, renal, and lung metastases. J Clin Neurosci 2017; 41:11-23. [PMID: 28462790 DOI: 10.1016/j.jocn.2017.04.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 04/03/2017] [Indexed: 10/19/2022]
Abstract
Metastatic spinal disease most frequently arises from carcinomas of the breast, lung, prostate, and kidney. Management of spinal metastases (SpM) is controversial in the literature. Recent studies advocate more aggressive surgical resection than older studies which called for radiation therapy alone, challenging previously held beliefs in conservative therapy. A literature search of the PubMed database was performed for spinal oncology outcome studies published in the English language between 2006 and 2016. Data concerning study characteristics, patient demographics, tumor origin and spinal location, treatment paradigm, and median survival were collected. The search retrieved 220 articles, 24 of which were eligible to be included. There were overall 3457 patients. Nine studies of 1723 patients discussed parameters affecting median survival time with comparison of different primary cancers. All studies found that primary cancer significantly predicted survival. Median survival time was highest for primary breast and renal cancers and lowest for prostate and lung cancers, respectively. Multiple spinal metastases, a cervical location of metastasis, and pathologic fracture each had no significant influence on survival. Survival in metastatic spinal tumors is largely driven by primary tumor type, and this should influence palliative management decisions. Surgery has been shown to greatly increase quality of life in patients who can tolerate the procedure, even in those previously treated with radiotherapy. Surgery for SpM can be used as first-line therapy for preservation of function and symptom relief. Future studies of management of SpM are warranted and primary tumor diagnosis should be studied to determine contribution to survival.
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Affiliation(s)
- Amy Yao
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, 1 Gustave L. Levy Place, New York, NY 10029, USA
| | - Christopher A Sarkiss
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, 1 Gustave L. Levy Place, New York, NY 10029, USA
| | - Travis R Ladner
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, 1 Gustave L. Levy Place, New York, NY 10029, USA
| | - Arthur L Jenkins
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, 1 Gustave L. Levy Place, New York, NY 10029, USA.
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Bakar D, Tanenbaum JE, Phan K, Alentado VJ, Steinmetz MP, Benzel EC, Mroz TE. Decompression surgery for spinal metastases: a systematic review. Neurosurg Focus 2017; 41:E2. [PMID: 27476844 DOI: 10.3171/2016.6.focus16166] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aim of this study was to systematically review the literature on reported outcomes following decompression surgery for spinal metastases. METHODS The authors conducted MEDLINE, Scopus, and Web of Science database searches for studies reporting clinical outcomes and complications associated with decompression surgery for metastatic spinal tumors. Both retrospective and prospective studies were included. After meeting inclusion criteria, articles were categorized based on the following reported outcomes: survival, ambulation, surgical technique, neurological function, primary tumor histology, and miscellaneous outcomes. RESULTS Of the 4148 articles retrieved from databases, 36 met inclusion criteria. Of those included, 8 were prospective studies and 28 were retrospective studies. The year of publication ranged from 1992 to 2015. Study size ranged from 21 to 711 patients. Three studies found that good preoperative Karnofsky Performance Status (KPS ≥ 80%) was a significant predictor of survival. No study reported a significant effect of time-to-surgery following the onset of spinal cord compression symptoms on survival. Three studies reported improvement in neurological function following surgery. The most commonly cited complication was wound infection or dehiscence (22 studies). Eight studies reported that preoperative ambulatory or preoperative motor status was a significant predictor of postoperative ambulatory status. A wide variety of surgical techniques were reported: posterior decompression and stabilization, posterior decompression without stabilization, and posterior decompression with total or subtotal tumor resection. Although a wide range of functional scales were used to assess neurological outcomes, four studies used the American Spinal Injury Association (ASIA) Impairment Scale to assess neurological function. Four studies reported the effects of radiation therapy and local disease control for spinal metastases. Two studies reported that the type of treatment was not significantly associated with the rate of local control. The most commonly reported primary tumor types included lung cancer, prostate cancer, breast cancer, renal cancer, and gastrointestinal cancer. CONCLUSIONS This study reports a systematic review of the literature on decompression surgery for spinal metastases. The results of this study can help educate surgeons on the previously published predictors of outcomes following decompression surgery for metastatic spinal disease. However, the authors also identify significant gaps in the literature and the need for future studies investigating the optimal practice with regard to decompression surgery for spinal metastases.
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Affiliation(s)
- Dara Bakar
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Joseph E Tanenbaum
- Center for Spine Health, and ,Case Western Reserve University School of Medicine;,Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio
| | - Kevin Phan
- NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia; and.,University of New South Wales, Sydney, Australia
| | - Vincent J Alentado
- Center for Spine Health, and ,Case Western Reserve University School of Medicine
| | | | - Edward C Benzel
- Center for Spine Health, and ,Departments of 2 Neurosurgery and
| | - Thomas E Mroz
- Center for Spine Health, and ,Departments of 2 Neurosurgery and.,Orthopaedic Surgery, Cleveland Clinic
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Nater A, Martin AR, Sahgal A, Choi D, Fehlings MG. Symptomatic spinal metastasis: A systematic literature review of the preoperative prognostic factors for survival, neurological, functional and quality of life in surgically treated patients and methodological recommendations for prognostic studies. PLoS One 2017; 12:e0171507. [PMID: 28225772 PMCID: PMC5321441 DOI: 10.1371/journal.pone.0171507] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 01/03/2017] [Indexed: 12/13/2022] Open
Abstract
Purpose While several clinical prediction rules (CPRs) of survival exist for patients with symptomatic spinal metastasis (SSM), these have variable prognostic ability and there is no recognized CPR for health related quality of life (HRQoL). We undertook a critical appraisal of the literature to identify key preoperative prognostic factors of clinical outcomes in patients with SSM who were treated surgically. The results of this study could be used to modify existing or develop new CPRs. Methods Seven electronic databases were searched (1990–2015), without language restriction, to identify studies that performed multivariate analysis of preoperative predictors of survival, neurological, functional and HRQoL outcomes in surgical patients with SSM. Individual studies were assessed for class of evidence. The strength of the overall body of evidence was evaluated using GRADE for each predictor. Results Among 4,818 unique citations, 17 were included; all were in English, rated Class III and focused on survival, revealing a total of 46 predictors. The strength of the overall body of evidence was very low for 39 and low for 7 predictors. Due to considerable heterogeneity in patient samples and prognostic factors investigated as well as several methodological issues, our results had a moderately high risk of bias and were difficult to interpret. Conclusions The quality of evidence for predictors of survival was, at best, low. We failed to identify studies that evaluated preoperative prognostic factors for neurological, functional, or HRQoL outcomes in surgical patients with SSM. We formulated methodological recommendations for prognostic studies to promote acquiring high-quality evidence to better estimate predictor effect sizes to improve patient education, surgical decision-making and development of CPRs.
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Affiliation(s)
- Anick Nater
- Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Allan R. Martin
- Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Canada
| | - David Choi
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, and Institute of Neurology, University College London, London, United Kingdom
| | - Michael G. Fehlings
- Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
- Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- * E-mail:
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Nater A, Tetreault LL, Davis AM, Sahgal AA, Kulkarni AV, Fehlings MG. Key Preoperative Clinical Factors Predicting Outcome in Surgically Treated Patients with Metastatic Epidural Spinal Cord Compression: Results from a Survey of 438 AOSpine International Members. World Neurosurg 2016; 93:436-448.e15. [DOI: 10.1016/j.wneu.2016.07.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 07/05/2016] [Accepted: 07/06/2016] [Indexed: 11/16/2022]
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Meng T, Chen R, Zhong N, Fan T, Li B, Yin H, Li Z, Zhou W, Song D, Xiao J. Factors associated with improved survival following surgical treatment for metastatic prostate cancer in the spine: retrospective analysis of 29 patients in a single center. World J Surg Oncol 2016; 14:200. [PMID: 27472919 PMCID: PMC4966823 DOI: 10.1186/s12957-016-0961-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 07/23/2016] [Indexed: 11/27/2022] Open
Abstract
Background Prostate cancer (PCa) is very common and frequently metastasizes to the spine. However, PCa spinal metastases were rarely reported in the literature. In this study, the outcome of therapies and prognostic factors affecting surgical outcomes for patients with PCa spinal metastases are discussed to select the best candidates for aggressive surgical resection. Methods All patients affected by the spinal metastatic PCa surgically treated at our spine tumor center were reviewed. Overall survival was analyzed from the time of spinal surgery. A univariate survival analysis and a multivariate Cox proportional hazard analysis to identify independent prognostic factors were carried out. The survival rate was estimated by the Kaplan-Meier method, and differences were analyzed by the log-rank test. Factors with P values of 0.1 or less were subjected to multivariate analysis for survival rate by multivariate Cox proportional hazard analysis. Results A total of 31 consecutive patients were identified. Of these, 29 underwent surgical resection. The median survival time of all patients after their spinal surgery was 44.0 months. Visceral metastases, revised Tokuhashi scores (0–8/9–11/12–15), Tomita scores (7–10/2–6), hormone status, and bisphosphonate treatment were suggested as the potential prognostic factors through univariate analysis. As they were submitted to the multivariate Cox regression model, visceral metastases and Tomita score were found as independent prognostic factors. Conclusions Patients without visceral metastases and a Tomita score no more than 6 are favorable prognostic factors for PCa metastases in the mobile spine.
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Affiliation(s)
- Tong Meng
- Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China.
| | - Rui Chen
- Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, China
| | - Nanzhe Zhong
- Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Tianqi Fan
- Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Bo Li
- Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Huabin Yin
- Department of Orthopedics, Shanghai Jiao Tong University, Shanghai First People's Hospital, No. 100 Haining Road, Shanghai, 200080, China
| | - Zhenxi Li
- Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Wang Zhou
- Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Dianwen Song
- Department of Orthopedics, Shanghai Jiao Tong University, Shanghai First People's Hospital, No. 100 Haining Road, Shanghai, 200080, China.
| | - Jianru Xiao
- Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China.
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Yu JI, Park HC, Ahn YC, Chung Y, Koom WS, Song SY. Variation in Practice Patterns of Korean Radiation Oncologists for Spine Metastasis between 2009 and 2014. Cancer Res Treat 2015; 48:1102-9. [PMID: 26639199 PMCID: PMC4946360 DOI: 10.4143/crt.2015.207] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 11/07/2015] [Indexed: 11/21/2022] Open
Abstract
PURPOSE The Korean Society of Radiation Oncologists (KOSRO) conducted the Patterns of Care Study (PCS) of radiotherapy (RT) for spine metastases in 2009. The current study was conducted to investigate current practice patterns and compare them with the results of the PCS. MATERIALS AND METHODS The survey questionnaire was composed of 10 questions regarding general information and seven questions for each of two clinical scenarios. RESULTS Fifty-four members of the KOSRO answered at least one question on the web-based questionnaire. The yearly number of patients treated who underwent palliative spine RT was greater than 200 in 14 (25.9%), 51 to 100 in 13 (24.1%), and 31 to 50 in 11 respondents (20.4%). Scenario 1 described a patient presenting with cord compressive spine metastasis in multiple bones and liver metastasis from non-small cell lung cancer. Thirty gray (Gy) in 10 fractions was chosen by 35 respondents (64.8%). Scenario 2 described a case of a single spine metastasis without progression after targeted therapy. Thirty Gy in 10 fractions was chosen by 19 respondents (35.2%), and a single fraction or less than four fractions of stereotactic ablative radiotherapy (SABR) were selected by 18 respondents (33.3%). When compared with the 2009 PCS, practice patterns of Korean radiation oncologists had not changed significantly over 5 years, except that SABR emerged as a new treatment modality in the selected population. CONCLUSION The 2014 PCS demonstrated that multiple fraction RT is still preferred in a considerable proportion of Korean radiation oncologists.
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Affiliation(s)
- Jeong Il Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Chul Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Yoonsun Chung
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woong Sub Koom
- Department of Radiation Oncology, Yonsei Institute for Cancer Research, Yonsei University College of Medicine, Seoul, Korea
| | - Si Yeol Song
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Lei M, Liu Y, Tang C, Yang S, Liu S, Zhou S. Prediction of survival prognosis after surgery in patients with symptomatic metastatic spinal cord compression from non-small cell lung cancer. BMC Cancer 2015; 15:853. [PMID: 26541141 PMCID: PMC4635615 DOI: 10.1186/s12885-015-1852-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 10/27/2015] [Indexed: 02/03/2023] Open
Abstract
Background The aim of this study was to develop a scoring system for prediction of survival prognosis after surgery in patients with symptomatic metastatic spinal cord compression (MSCC) from non-small cell lung cancer (NSCLC). Methods We retrospectively analyzed nine preoperative characteristics for survival in a series of 64 patients with NSCLC who were operated with posterior decompression and spine stabilization for MSCC. Characteristics significantly associated with survival on multivariate analysis were included in the scoring system. The scoring point for each significant characteristic was derived from the hazard ratios on Cox proportional hazards model. The total score for each patient was obtained by adding the scoring points of all significant characteristics. Results Eastern Cooperative Oncology Group (ECOG) performance status, number of involved vertebrae, visceral metastases, and time developing motor deficits had significant impact on survival on multivariate analysis and were included in the scoring system. According to the prognostic scores, which ranged from 4 to 10 points, three prognostic groups were designed: 4–5 points (n = 22), 6–7 points (n = 23), and 8–10 points (n = 19). The corresponding 6-month survival rates were 95, 47 and 11 %, respectively (P < 0.0001). In addition, the functional outcome was worse in the group of patients with 8–10 points compared with other two prognostic groups. Conclusions The new scoring system will enable physicians to identify patient with MSCC from NSCLC who may be a candidate for decompression and spine stabilization, more radical surgery, or supportive care alone. Patients with scores of 4–5, who have the most favorable survival prognosis and functional outcome, can be treated with more radical surgery in order to realize better local control of disease and prevent the occurrence of local disease. Patients with scores of 6–7 points should be surgical candidates, because survival prognosis and functional outcome are acceptable after surgery, while patients with scores of 8–10 points, who have the shortest survival time and poorest functional outcome after surgery, appear to be best treated with radiotherapy or best supportive care.
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Affiliation(s)
- Mingxing Lei
- Department of Orthopedic Surgery, Affiliated Hospital of Academy of Military Medical Sciences, No. 8, Fengtaidongda Rd, Beijing, 100071, People's Republic of China.
| | - Yaosheng Liu
- Department of Orthopedic Surgery, Affiliated Hospital of Academy of Military Medical Sciences, No. 8, Fengtaidongda Rd, Beijing, 100071, People's Republic of China.
| | - Chuanghao Tang
- Department of Pulmonary Neoplasms Internal Medicine, Affiliated Hospital of Academy of Military Medical Sciences, No. 8, Fengtaidongda Rd, Beijing, China.
| | - Shaoxing Yang
- Department of Pulmonary Neoplasms Internal Medicine, Affiliated Hospital of Academy of Military Medical Sciences, No. 8, Fengtaidongda Rd, Beijing, China.
| | - Shubin Liu
- Department of Orthopedic Surgery, Affiliated Hospital of Academy of Military Medical Sciences, No. 8, Fengtaidongda Rd, Beijing, 100071, People's Republic of China.
| | - Shiguo Zhou
- Statistics Room, Capital Medical University affiliated Beijing Friendship Hospital, No. 95, Xuanwu District Yongan Rd, Beijing, China.
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Fortin CD, Voth J, Jaglal SB, Craven BC. Inpatient rehabilitation outcomes in patients with malignant spinal cord compression compared to other non-traumatic spinal cord injury: A population based study. J Spinal Cord Med 2015; 38:754-64. [PMID: 25615237 PMCID: PMC4725809 DOI: 10.1179/2045772314y.0000000278] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE To compare and describe demographic characteristics, clinical, and survival outcomes in patients admitted for inpatient rehabilitation following malignant spinal cord compression (MSCC) or other causes of non-traumatic spinal cord injury (NT-SCI). DESIGN A retrospective cohort design was employed, using data retrieved from administrative databases. SETTING Rehabilitation facilities or designated rehabilitation beds in Ontario, Canada, from April 2007 to March 2011. PARTICIPANTS Patients with incident diagnoses of MSCC (N = 143) or NT-SCI (N = 1,274) admitted for inpatient rehabilitation. OUTCOME MEASURES Demographic, impairment, functional outcome (as defined by the Functional Independence Measure (FIM)), discharge, healthcare utilization, survival, and tumor characteristics. RESULTS There was a significant improvement in the FIM from admission to discharge (mean change 20.1 ± 14.3, <0.001) in the MSCC cohort. NT-SCI patients demonstrated a higher FIM efficiency (1.2 ± 1.7 vs. 0.8 ± 0.8, <0.001) and higher total (24.0 ± 14.4 vs. 20.1 ± 14.3, <0.001) FIM gains relative to MSCC cases. However, there were no differences between the MSCC and NT-SCI cohorts in length of stay (34.6 ± 30.3 vs. 37.5 ± 35.2, P = 0.8) or discharge FIM (100.7 ± 19.6 vs. 103.3 ± 18.1, P = 0.1). Three-month, 1-year, and 3-year survival rates in the MSCC and NT-SCI cohorts were 76.2% vs. 97.6%, 46.2% vs. 93.7%, and 27.3% vs. 86.7%, respectively. The majority (65.0%) of patients with MSCC was discharged home and met their rehabilitation goals (75.5%) at comparable rates to patients with NT-SCI (69.7 and 81.3%). CONCLUSION Despite compromised survival, patients with MSCC make clinically significant functional gains and exhibit favorable discharge outcomes following inpatient rehabilitation. Current administrative data suggests the design and scope of inpatient rehabilitation services should reflect the unique survival-related prognostic factors in patients with MSCC.
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Affiliation(s)
| | - Jennifer Voth
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | | | - B. Catharine Craven
- Correspondence to: B. Catharine Craven, Toronto Rehabilitation Institute, Lyndhurst Centre, 520 Sutherland Drive, Toronto, ON M4G 3V9, Canada.
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Kim J, Lee SH, Park SJ, Chung SS, Kim ES, Eoh W, Lee CS. Analysis of the predictive role and new proposal for surgical strategies based on the modified Tomita and Tokuhashi scoring systems for spinal metastasis. World J Surg Oncol 2014; 12:245. [PMID: 25085251 PMCID: PMC4124481 DOI: 10.1186/1477-7819-12-245] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 07/20/2014] [Indexed: 02/02/2023] Open
Abstract
Background We sought to identify preoperative factors significantly correlated with survival. We also aimed to evaluate the validity of the prognostic scores in the Tomita and Tokuhashi systems and discuss several aspects to improve the predictive accuracy of these systems. Moreover, we suggest modified criteria for selecting treatment strategies. Methods In total, the outcomes of 112 patients with spinal metastasis who underwent surgery between January 2006 and June 2011 were retrospectively reviewed. The validity of the prognostic scores was assessed on the basis of their correlation with survival. For various primary malignancies, new scoring criteria were applied in each system according to the survival results obtained in this study. Each revised scoring system was adjusted with a similar principle of scoring as described previously. Patient survival according to each preoperative factor was analyzed by the Kaplan-Meier method. The predictive value of each scoring system was evaluated by the log-rank test and Cox regression analysis. Results The interval from the diagnosis of the primary malignancy to that of spinal metastasis (p = 0.023) and the interval from the diagnosis of spinal metastasis to surgery (p = 0.039) were significantly correlated with survival. Regarding Tokuhashi scores, the correlation coefficient was 0.790 before adjustment (p = 0.001) and 0.853 after adjustment (p < 0.001). For Tomita scores, the correlation coefficient was -0.994 (p < 0.001) both before and after adjustment. Conclusions Tomita scores more accurately predicted survival than Tokuhashi scores. It is helpful to evaluate both scoring systems with adjustment for primary malignancy depending on the clinical setting. Patients with Tomita scores less than or equal to 8 and Tokuhashi scores greater than or equal to 6 are recommended to undergo surgical management.
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Affiliation(s)
| | - Sun-Ho Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, 135-710 Seoul, Gangnam-gu, South Korea.
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Tokuhashi Y, Uei H, Oshima M, Ajiro Y. Scoring system for prediction of metastatic spine tumor prognosis. World J Orthop 2014; 5:262-271. [PMID: 25035829 PMCID: PMC4095019 DOI: 10.5312/wjo.v5.i3.262] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/24/2014] [Accepted: 05/16/2014] [Indexed: 02/06/2023] Open
Abstract
Assessing the prognosis before treatment for metastatic spine tumor is extremely important in therapy selection. Therefore, we review some prognostic scoring systems and their outcomes. Articles with combinations of two keywords among “metastatic spine tumor” and “prognosis”, “score”, “scoring system”, “predicting”, or “life expectancy” were searched for in PubMed. As a result, 236 articles were extracted. Those referring to representative scoring systems about predicting the survival of patients with metastatic spine tumors were used. The significance and limits of these scoring systems, and the future perspectives were described. Tokuhashi score, Tomita score, Baur score, Linden score, Rades score, and Katagiri score were introduced. They are all scoring systems prepared by combining factors that affect prognosis. The primary site of cancer and visceral metastasis were common factors in all of these scoring systems. Other factors selected to influence the prognosis varied. They were useful to roughly predict the survival period, such as, “more than one year or not” or “more than six months or not”. In particular, they were utilized for decision-making about operative indications and avoidance of excessive medical treatment. Because the function depended on the survival period in the patients with metastatic spine tumor, it was also utilized in assessing functional prognosis. However, no scoring system had more than 90% consistency between the predicted and actual survival periods. Future perspectives should adopt more oncological viewpoints with adjustment of the process of treatment for metastatic spine tumor.
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Jernberg E, Thysell E, Bovinder Ylitalo E, Rudolfsson S, Crnalic S, Widmark A, Bergh A, Wikström P. Characterization of prostate cancer bone metastases according to expression levels of steroidogenic enzymes and androgen receptor splice variants. PLoS One 2013; 8:e77407. [PMID: 24244276 PMCID: PMC3820691 DOI: 10.1371/journal.pone.0077407] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 09/02/2013] [Indexed: 11/18/2022] Open
Abstract
Background Intra-tumoral steroidogenesis and constitutive androgen receptor (AR) activity have been associated with castration-resistant prostate cancer (CRPC). This study aimed to examine if CRPC bone metastases expressed higher levels of steroid-converting enzymes than untreated bone metastases. Steroidogenic enzyme levels were also analyzed in relation to expression of constitutively active AR variants (AR-Vs) and to clinical and pathological variables. Methodology/Principal Findings Untreated, hormone-naïve (HN, n = 9) and CRPC bone metastases samples (n = 45) were obtained from 54 patients at metastasis surgery. Non-malignant and malignant prostate samples were acquired from 13 prostatectomy specimens. Transcript and protein levels were analyzed by real-time RT-PCR, immunohistochemistry and immunoblotting. No differences in steroidogenic enzyme levels were detected between CRPC and HN bone metastases. Significantly higher levels of SRD5A1, AKR1C2, AKR1C3, and HSD17B10 mRNA were however found in bone metastases than in non-malignant and/or malignant prostate tissue, while the CYP11A1, CYP17A1, HSD3B2, SRD5A2, and HSD17B6 mRNA levels in metastases were significantly lower. A sub-group of metastases expressed very high levels of AKR1C3, which was not due to gene amplification as examined by copy number variation assay. No association was found between AKR1C3 expression and nuclear AR staining, tumor cell proliferation or patient outcome after metastases surgery. With only one exception, high AR-V protein levels were found in bone metastases with low AKR1C3 levels, while metastases with high AKR1C3 levels primarily contained low AR-V levels, indicating distinct mechanisms behind castration-resistance in individual bone metastases. Conclusions/Significance Induced capacity of converting adrenal-gland derived steroids into more potent androgens was indicated in a sub-group of PC bone metastases. This was not associated with CRPC but merely with the advanced stage of metastasis. Sub-groups of bone metastases could be identified according to their expression levels of AKR1C3 and AR-Vs, which might be of relevance for patient response to 2nd line androgen-deprivation therapy.
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Affiliation(s)
- Emma Jernberg
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | - Elin Thysell
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | | | - Stina Rudolfsson
- Department of Surgical and Perioperative Sciences, Orthopedics and Urology and Andrology, Umeå University, Umeå, Sweden
| | - Sead Crnalic
- Department of Surgical and Perioperative Sciences, Orthopedics and Urology and Andrology, Umeå University, Umeå, Sweden
| | - Anders Widmark
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Anders Bergh
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | - Pernilla Wikström
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
- * E-mail:
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Joniau S, Pfister D, de la Taille A, Gaboardi F, Thompson A, Ribal MJ. Controversies on individualized prostate cancer care: gaps in current practice. Ther Adv Urol 2013; 5:233-44. [PMID: 24082918 DOI: 10.1177/1756287213490053] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Prostate cancer (PCa) is a heterogeneous disease with a wide spectrum of aggressiveness. Evidence-based guidelines are invaluable but cannot be expected to be extensive enough to provide detailed guidance on the management of all patients. As such, the use of individualized, risk-adapted approaches to the management of PCa is indispensable. However, wide variation in treatment approaches observed for patients in practice suggests that there is an unmet need to improve the individualized approach towards patient care. A holistic approach that encompasses guidelines and evidence-based medicine could be used to guide individualized care for patients with PCa, from first contact through to final outcomes. As a result of an international expert meeting, this paper proposes this approach and highlights some of the factors that can be considered when aiming to identify patients' profiles; individualize treatment; and improve communication between patients and the healthcare teams.
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