Characteristics of Patients Who Survived < 3 Months or > 2 Years After Surgery for Spinal Metastases: Can We Avoid Inappropriate Patient Selection?
Por:
Verlaan, J, Choi, D, Versteeg, A, Albert, T, Arts, M, Balabaud, L, Bunger, C, Buchowski, J, Chung, C, Coppes, M, Crockard, H, Depreitere, B, Fehlings, M, Harrop, J, Kawahara, N, Kim, E, Lee, C, Leung, Y, Liu, Z, Martin-Benlloch, A, Massicotte, E, Mazel, C, Meyer, B, Peul, W, Quraishi, N, Tokuhashi, Y, Tomita, K, Ulbricht, C, Wang, M and Oner, F
Publicada:
1 sep 2016
Resumen:
Purpose
Survival after metastatic cancer has improved at the cost of increased
presentation with metastatic spinal disease. For patients with
pathologic spinal fractures and/or spinal cord compression, surgical
intervention may relieve pain and improve quality of life. Surgery is
generally considered to be inappropriate if anticipated survival is, 3
months. The aim of this international multicenter study was to analyze
data from patients who died within 3 months or 2 years after surgery, to
identify preoperative factors associated with poor or good survival, and
to avoid inappropriate selection of patients for surgery in the future.
Patients and Methods
A total of 1,266 patients underwent surgery for impending pathologic
fractures and/or neurologic deficits and were prospectively observed.
Data collected included tumor characteristics, preoperative fitness
(American Society of Anesthesiologists advisory [ASA]), neurologic
status (Frankel scale), performance (Karnofsky performance score [KPS]),
and quality of life (EuroQol five-dimensions questionnaire [EQ-5D]).
Outcomes were survival at 3 months and 2 years postsurgery. Univariable
and multivariable logistic regression analyses were used to find
preoperative factors associated with short-term and long-term survival.
Results
In univariable analysis, age, emergency surgery, KPS, EQ-5D, ASA,
Frankel, and Tokuhashi/Tomita scores were significantly associated with
short survival. In multivariable analysis, KPS and age were
significantly associated with short survival (odds ratio [OR], 1.36; 95%
CI, 1.15 to 1.62; and OR, 1.14; 95% CI, 1.02 to 1.27, respectively).
Associated with longer survival in univariable analysis were age, number
of levels included in surgery, KPS, EQ-5D, Frankel, and Tokuhashi/Tomita
scores. In multivariable analysis, the number of levels included in
surgery (OR, 1.21; 95% CI, 1.06 to 1.38) and primary tumor type were
significantly associated with longer survival.
Conclusion
Poor performance status at presentation is the strongest indicator of
poor short-term survival, whereas low disease load and favorable tumor
histology are associated with longer-term survival. (C) 2016 by American
Society of Clinical Oncology
Filiaciones:
Verlaan, J:
Univ Med Ctr Utrecht, Room G-05-228,Heidelberglaan 100, NL-3584 CX Utrecht, Netherlands
Choi, D:
UCL, Natl Hosp Neurol & Neurosurg, London, England
Versteeg, A:
Univ Med Ctr Utrecht, Room G-05-228,Heidelberglaan 100, NL-3584 CX Utrecht, Netherlands
Albert, T:
Thomas Jefferson Univ & Hosp, Philadelphia, PA USA
Arts, M:
Med Ctr Haaglanden, The Hague, Netherlands
Balabaud, L:
Inst Mutualiste Montsouris, Paris, France
Bunger, C:
Aarhus Univ Hosp, Aarhus, Denmark
Buchowski, J:
Washington Univ, St Louis, MO USA
Chung, C:
Seoul Natl Univ, Seoul, South Korea
Coppes, M:
Univ Groningen, Univ Med Ctr Groningen, Groningen, Netherlands
Crockard, H:
UCL, Natl Hosp Neurol & Neurosurg, London, England
Depreitere, B:
Univ Hosp Leuven, Leuven, Belgium
Fehlings, M:
Toronto Western Hosp, Toronto, ON, Canada
Harrop, J:
Thomas Jefferson Univ & Hosp, Philadelphia, PA USA
Kawahara, N:
Kanazawa Med Univ Hosp, Kanazawa, Ishikawa, Japan
Kim, E:
Sungkyunkwan Univ, Sch Med, Samsung Med Ctr, Seoul, South Korea
Lee, C:
Sungkyunkwan Univ, Sch Med, Samsung Med Ctr, Seoul, South Korea
Leung, Y:
Musgrove Pk Hosp, Taunton, Somerset, England
Liu, Z:
Peking Univ Hosp, Beijing, Peoples R China
:
Hosp Univ Dr Peset, Valencia, Spain
Massicotte, E:
Toronto Western Hosp, Toronto, ON, Canada
Mazel, C:
Inst Mutualiste Montsouris, Paris, France
Meyer, B:
Tech Univ Munich, Munich, Germany
Peul, W:
Leiden Univ, Med Ctr, Leiden, Netherlands
Quraishi, N:
Queens Med Ctr, Nottingham, England
Tokuhashi, Y:
Nihon Univ, Sch Med, Tokyo, Japan
Tomita, K:
Kanazawa Univ, Kanazawa, Ishikawa, Japan
Ulbricht, C:
Charing Cross Hosp, London, England
Wang, M:
Univ Miami, Jackson Mem Hosp, Miami, FL 33136 USA
Oner, F:
Univ Med Ctr Utrecht, Room G-05-228,Heidelberglaan 100, NL-3584 CX Utrecht, Netherlands
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