Relationship Between Visceral Metastases and Survival in Patients with Metastasis-related Spinal Cord Compression.

Autor: Lun DX; Department of Spine Surgery, Weifang People's Hospital, Weifang, Shandong, China., Wang XD; Tianjin Traditional Chinese Medicine University, Tianjin, China., Ji YD; Department of Orthopaedic, Sunshine Union Hospital, Weifang, Shandong, China., Hu YC; Department of Bone Oncology, Tianjin Hospital, Tianjin, China., Yang XG; Department of Bone Oncology, Tianjin Hospital, Tianjin, China., Yu XC; Department of Orthopaedic Oncology, Jinan Military General Hospital, Jinan, China., Zhang GC; Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang Shi, Hebei Sheng, China., Zhuang QS; Department of Spine Surgery, Weifang People's Hospital, Weifang, Shandong, China.
Jazyk: angličtina
Zdroj: Orthopaedic surgery [Orthop Surg] 2019 Jun; Vol. 11 (3), pp. 414-421. Date of Electronic Publication: 2019 Apr 15.
DOI: 10.1111/os.12465
Abstrakt: Objective: To investigate whether visceral metastases have a significant impact on survival in patients with metastasis-related spinal cord compression (MSCC), and to determine the difference in prognosis between patients with and without visceral metastases.
Methods: Three institutional databases were searched to identify all patients who had undergone spinal surgery for spinal metastases between March 2002 and June 2010. Data on patient characteristics including pre- and post-operative medical conditions, were collected from medical records or by telephone follow-up. Survival data were obtained either from medical records or by searching a governmental cancer registry.
Results: The mean age of study patients was 59.6 ± 10.5 years (range, 18-84 years), of whom 102 were male and 67 female. The median and mean postoperative survival times were 7.0 ± 0.5 (95% CI 6.0-8.0) months and 12.6 ± 1.2 (95% CI 10.1-15.0) months, respectively, in all patients, being 5.0 ± 0.5 (95% CI 4.0-6.0) months and 10.8 ± 2.4 (95% CI 6.1-15.5) months, respectively, for patients with visceral metastases and 7.0 ± 0.8 (95% CI 5.4-8.6) months and 13.0 ± 1.4 (95%CI 10.3-15.6) months, respectively, for patients without visceral metastases (P = 0.87). These survival times did not differ significantly between groups. Multivariate Cox proportional hazard regressions showed that visceral metastases had no statistically significant association with survival (P = 0.277), whereas rate of growth of primary tumor (P = 0.003), preoperative Karnofsky performance status (KPS) (P < 0.001), change in KPS (P < 0.001), and Frankel grade (P = 0.091) were independent prognostic factors in the whole cohort (P = 0.005). Changes in KPS (P = 0.001) and major complications (P = 0.003) were significantly associated with survival in patients with visceral metastases, whereas rate of growth of primary tumor (P = 0.016), change in KPS (P = 0.001), and preoperative KPS (P < 0.001) were significantly associated with survival in patients without visceral metastases.
Conclusions: Visceral metastases do not appear to predict the prognosis of patients with MSCC; thus, more aggressive surgery should be considered in patients with MSCC who have visceral metastases. Additionally, prognostic factors differ according to visceral metastases status in these patients.
(© 2019 The Authors. Orthopaedic Surgery published by Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.)
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje