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01-05-2020 | Metastasis | Original Article

Outcomes of surgical treatments of spinal metastases: a prospective study

Authors: C. Bouthors, S. Prost, C. Court, B. Blondel, Y. P. Charles, S. Fuentes, H. P. Mousselard, C. Mazel, C. H. Flouzat-Lachaniette, P. Bonnevialle, F. Saihlan, the SOFCOT

Published in: Supportive Care in Cancer | Issue 5/2020

Abstract

Background

Owing to recent advances in cancer therapy, updated data are required for clinicians counselling patients on treatment of spinal metastases.

Objective

To analyse the outcomes of surgical treatments of spinal metastases.

Methods

Prospective and multicentric study that included consecutively patients operated on for spinal metastases between January 2016 and January 2017. Overall survival was calculated with the Kaplan-Meier method. Cox proportional hazard model was used to calculate hazard ratio (HR) analysing mortality risk according to preoperative Karnofsky performance status (KPS), mobility level and neurological status.

Results

A total of 252 patients were included (145 males, 107 females) aged a mean 63.3 years. Median survival was 450 days. Primary cancer sites were lung (21%) and breast (19%). Multiple spinal metastases involved 122 patients (48%). Concomitant skeletal and visceral metastases were noted in 90 patients (36%). Main procedure was laminectomy and posterior fixation (57%). Overall, pain and mobility level were improved postoperatively. Most patients had normal preoperative motor function (50%) and remained so postoperatively. Patients “bedbound” on admission were the less likely to recover. In-hospital death rate was 2.4% (three disease progression, one septic shock, one pneumonia, one pulmonary embolism). Complication rate was 33%, deep wound infection was the most frequent aetiology. Higher mortality was observed in patients with poorest preoperative KPS (KPS 0–40%, HR = 3.1, p < 0.001) and mobility level (“bedbound”, HR = 2.16, p < 0.001). Survival seemed also to be linked to preoperative neurological function.

Conclusion

Surgical treatments helped maintain reasonable condition for patients with spinal metastases. Intervention should be offered before patients’ condition worsen to ensure better outcomes.

Cole JS, Patchell RA (2008) Metastatic epidural spinal cord compression. Lancet Neurol 7:459–466. https://doi.org/10.1016/S1474-4422(08)70089-9 CrossRefPubMed

Yoshihara H, Yoneoka D (2014) Trends in the surgical treatment for spinal metastasis and the in-hospital patient outcomes in the United States from 2000 to 2009. Spine J Off J North Am Spine Soc 14:1844–1849. https://doi.org/10.1016/j.spinee.2013.11.029 CrossRef

Barzilai O, Boriani S, Fisher CG, Sahgal A, Verlaan JJ, Gokaslan ZL, Lazary A, Bettegowda C, Rhines LD, Laufer I (2019) Essential concepts for the Management of Metastatic Spine Disease: what the surgeon should know and practice. Glob Spine J 9:98S–107S. https://doi.org/10.1177/2192568219830323 CrossRef

White BD, Stirling AJ, Paterson E, Asquith-Coe K, Melder A, on behalf of the Guideline Development Group (2008) Diagnosis and management of patients at risk of or with metastatic spinal cord compression: summary of NICE guidance. BMJ 337:a2538. https://doi.org/10.1136/bmj.a2538 CrossRefPubMed

Ahmed AK, Goodwin CR, Heravi A, Kim R, Abu-Bonsrah N, Sankey E, Kerekes D, de la Garza Ramos R, Schwab J, Sciubba DM (2018) Predicting survival for metastatic spine disease: a comparison of nine scoring systems. Spine J Off J North Am Spine Soc 18:1804–1814. https://doi.org/10.1016/j.spinee.2018.03.011 CrossRef

Ghori AK, Leonard DA, Schoenfeld AJ, Saadat E, Scott N, Ferrone ML, Pearson AM, Harris MB (2015) Modeling 1-year survival after surgery on the metastatic spine. Spine J Off J North Am Spine Soc 15:2345–2350. https://doi.org/10.1016/j.spinee.2015.06.061 CrossRef

Wang M, Bünger CE, Li H, Wu C, Høy K, Niedermann B, Helmig P, Wang Y, Jensen AB, Schättiger K, Hansen ES (2012) Predictive value of Tokuhashi scoring systems in spinal metastases, focusing on various primary tumor groups: evaluation of 448 patients in the Aarhus spinal metastases database. Spine 37:573–582. https://doi.org/10.1097/BRS.0b013e31822bd6b0 CrossRefPubMed

Leithner A, Radl R, Gruber G, Hochegger M, Leithner K, Welkerling H, Rehak P, Windhager R (2008) Predictive value of seven preoperative prognostic scoring systems for spinal metastases. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 17:1488–1495. https://doi.org/10.1007/s00586-008-0763-1 CrossRef

Patchell RA, Tibbs PA, Regine WF, Payne R, Saris S, Kryscio RJ, Mohiuddin M, Young B (2005) Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet Lond Engl 366:643–648. https://doi.org/10.1016/S0140-6736(05)66954-1 CrossRef

10.

Schoenfeld AJ, Losina E, Ferrone ML, Schwab JH, Chi JH, Blucher JA, Silva GS, Chen AT, Harris MB, Kang JD, Katz JN (2019) Ambulatory status after surgical and nonsurgical treatment for spinal metastasis. Cancer. https://doi.org/10.1002/cncr.32140

11.

Doyle DJ, Garmon EH (2018) American Society of Anesthesiologists Classification (ASA class). StatPearls. StatPearls Publishing, Treasure Island

12.

Fisher CG, DiPaola CP, Ryken TC et al (2010) A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the spine oncology study group. Spine 35:E1221–E1229. https://doi.org/10.1097/BRS.0b013e3181e16ae2 CrossRefPubMed

13.

Tokuhashi Y, Matsuzaki H, Oda H, Oshima M, Ryu J (2005) A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. Spine 30:2186–2191CrossRef

14.

Tomita K, Kawahara N, Kobayashi T, Yoshida A, Murakami H, Akamaru T (2001) Surgical strategy for spinal metastases. Spine 26:298–306CrossRef

15.

Collins SL, Moore RA, McQuay HJ (1997) The visual analogue pain intensity scale: what is moderate pain in millimetres? Pain 72:95–97CrossRef

16.

Yates JW, Chalmer B, McKegney FP (1980) Evaluation of patients with advanced cancer using the Karnofsky performance status. Cancer 45:2220–2224CrossRef

17.

Frankel HL (1969) Ascending cord lesion in the early stages following spinal injury. Paraplegia 7:111–118. https://doi.org/10.1038/sc.1969.21 CrossRefPubMed

18.

Vanek P, Bradac O, Trebicky F et al (2015) Influence of the preoperative neurological status on survival after the surgical treatment of symptomatic spinal metastases with spinal cord compression. Spine 40:1824–1830. https://doi.org/10.1097/BRS.0000000000001141 CrossRefPubMed

19.

Choi D, Fox Z, Albert T, Arts M, Balabaud L, Bunger C, Buchowski JM, Coppes MH, Depreitere B, Fehlings MG, Harrop J, Kawahara N, Martin-Benlloch JA, Massicotte EM, Mazel C, Oner FC, Peul W, Quraishi N, Tokuhashi Y, Tomita K, Verlaan JJ, Wang M, Wang M, Crockard HA (2016) Rapid improvements in pain and quality of life are sustained after surgery for spinal metastases in a large prospective cohort. Br J Neurosurg 30:337–344. https://doi.org/10.3109/02688697.2015.1133802 CrossRefPubMed

20.

Ibrahim A, Crockard A, Antonietti P, Boriani S, Bünger C, Gasbarrini A, Grejs A, Harms J, Kawahara N, Mazel C, Melcher R, Tomita K (2008) Does spinal surgery improve the quality of life for those with extradural (spinal) osseous metastases? An international multicenter prospective observational study of 223 patients. Invited submission from the joint section meeting on disorders of the spine and peripheral nerves, march 2007. J Neurosurg Spine 8:271–278. https://doi.org/10.3171/SPI/2008/8/3/271 CrossRefPubMed

21.

Pointillart V, Vital J-M, Salmi R, Diallo A, Quan GM (2011) Survival prognostic factors and clinical outcomes in patients with spinal metastases. J Cancer Res Clin Oncol 137:849–856. https://doi.org/10.1007/s00432-010-0946-0 CrossRefPubMed

22.

Quan GMY, Vital J-M, Aurouer N, Obeid I, Palussière J, Diallo A, Pointillart V (2011) Surgery improves pain, function and quality of life in patients with spinal metastases: a prospective study on 118 patients. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 20:1970–1978. https://doi.org/10.1007/s00586-011-1867-6 CrossRef

23.

Fehlings MG, Nater A, Tetreault L, Kopjar B, Arnold P, Dekutoski M, Finkelstein J, Fisher C, France J, Gokaslan Z, Massicotte E, Rhines L, Rose P, Sahgal A, Schuster J, Vaccaro A (2016) Survival and clinical outcomes in surgically treated patients with metastatic epidural spinal cord compression: results of the prospective multicenter AOSpine study. J Clin Oncol Off J Am Soc Clin Oncol 34:268–276. https://doi.org/10.1200/JCO.2015.61.9338 CrossRef

24.

Kakutani K, Sakai Y, Maeno K, Takada T, Yurube T, Kurakawa T, Miyazaki S, Terashima Y, Ito M, Hara H, Kawamoto T, Ejima Y, Sakashita A, Kiyota N, Kizawa Y, Sasaki R, Akisue T, Minami H, Kuroda R, Kurosaka M, Nishida K (2017) Prospective cohort study of performance status and activities of daily living after surgery for spinal metastasis. Clin Spine Surg 30:E1026–E1032. https://doi.org/10.1097/BSD.0000000000000456 CrossRefPubMed

25.

Quraishi NA, Rajagopal TS, Manoharan SR, Elsayed S, Edwards KL, Boszczyk BM (2013) Effect of timing of surgery on neurological outcome and survival in metastatic spinal cord compression. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 22:1383–1388. https://doi.org/10.1007/s00586-012-2635-y CrossRef

26.

Chong S, Shin S-H, Yoo H, Lee SH, Kim KJ, Jahng TA, Gwak HS (2012) Single-stage posterior decompression and stabilization for metastasis of the thoracic spine: prognostic factors for functional outcome and patients’ survival. Spine J Off J North Am Spine Soc 12:1083–1092. https://doi.org/10.1016/j.spinee.2012.10.015 CrossRef

27.

Arrigo RT, Kalanithi P, Cheng I, Alamin T, Carragee EJ, Mindea SA, Park J, Boakye M (2011) Predictors of survival after surgical treatment of spinal metastasis. Neurosurgery 68:674–681; discussion 681. https://doi.org/10.1227/NEU.0b013e318207780c CrossRefPubMed

28.

Yang X-G, Han Y, Wang F, Liu YH, Hu YC, Lun DX, Feng JT, Hua KC, Yang L, Zhang H, Xu MY, Zhang HR (2018) Is ambulatory status a prognostic factor of survival in patients with spinal metastases? An exploratory meta-analysis. Orthop Surg 10:173–180. https://doi.org/10.1111/os.12393 CrossRefPubMedPubMedCentral

29.

Rades D, Fehlauer F, Schulte R, Veninga T, Stalpers LJA, Basic H, Bajrovic A, Hoskin PJ, Tribius S, Wildfang I, Rudat V, Engenhart-Cabilic R, Karstens JH, Alberti W, Dunst J, Schild SE (2006) Prognostic factors for local control and survival after radiotherapy of metastatic spinal cord compression. J Clin Oncol Off J Am Soc Clin Oncol 24:3388–3393. https://doi.org/10.1200/JCO.2005.05.0542 CrossRef

30.

van der Linden YM, Dijkstra SPDS, Vonk EJA, Marijnen CAM, Leer JWH, for The Dutch Bone Metastasis Study Group (2005) Prediction of survival in patients with metastases in the spinal column: results based on a randomized trial of radiotherapy. Cancer 103:320–328. https://doi.org/10.1002/cncr.20756 CrossRefPubMed

31.

Balain B, Jaiswal A, Trivedi JM, Eisenstein SM, Kuiper JH, Jaffray DC (2013) The Oswestry risk index: an aid in the treatment of metastatic disease of the spine. Bone Jt J 95-B:210–216. https://doi.org/10.1302/0301-620X.95B2.29323 CrossRef

32.

Yang X-G, Lun D-X, Hu Y-C, Liu YH, Wang F, Feng JT, Hua KC, Yang L, Zhang H, Xu MY, Zhang HR (2018) Prognostic effect of factors involved in revised Tokuhashi score system for patients with spinal metastases: a systematic review and meta-analysis. BMC Cancer 18:1248. https://doi.org/10.1186/s12885-018-5139-2 CrossRefPubMedPubMedCentral

33.

Wolf RJ, Foerster R, Bruckner T, Bostel T, Schlampp I, Debus J, Rief H, Group GBR (2016) Survival and prognostic factors in patients with stable and unstable spinal bone metastases from solid tumors: a retrospective analysis of 915 cases. BMC Cancer 16:528. https://doi.org/10.1186/s12885-016-2571-z CrossRefPubMedPubMedCentral

34.

Luksanapruksa P, Buchowski JM, Hotchkiss W, Tongsai S, Wilartratsami S, Chotivichit A (2017) Prognostic factors in patients with spinal metastasis: a systematic review and meta-analysis. Spine J Off J North Am Spine Soc 17:689–708. https://doi.org/10.1016/j.spinee.2016.12.003 CrossRef

35.

de OMF, Rotta JM, Botelho RV (2015) Survival analysis in patients with metastatic spinal disease: the influence of surgery, histology, clinical and neurologic status. Arq Neuropsiquiatr 73:330–335. https://doi.org/10.1590/0004-282X20150003 CrossRef

36.

Itshayek E, Candanedo C, Fraifeld S, Hasharoni A, Kaplan L, Schroeder JE, Cohen JE (2018) Ambulation and survival following surgery in elderly patients with metastatic epidural spinal cord compression. Spine J Off J North Am Spine Soc 18:1211–1221. https://doi.org/10.1016/j.spinee.2017.11.020 CrossRef

37.

Jansson K-A, Bauer HCF (2006) Survival, complications and outcome in 282 patients operated for neurological deficit due to thoracic or lumbar spinal metastases. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 15:196–202. https://doi.org/10.1007/s00586-004-0870-6 CrossRef

38.

Hirabayashi H, Ebara S, Kinoshita T, Yuzawa Y, Nakamura I, Takahashi J, Kamimura M, Ohtsuka K, Takaoka K (2003) Clinical outcome and survival after palliative surgery for spinal metastases: palliative surgery in spinal metastases. Cancer 97:476–484. https://doi.org/10.1002/cncr.11039 CrossRefPubMed

39.

Moon KY, Chung CK, Jahng T-A, Kim HJ, Kim CH (2011) Postoperative survival and ambulatory outcome in metastatic spinal tumors : prognostic factor analysis. J Korean Neurosurg Soc 50:216–223. https://doi.org/10.3340/jkns.2011.50.3.216 CrossRefPubMedPubMedCentral

40.

Wise JJ, Fischgrund JS, Herkowitz HN, Montgomery D, Kurz LT (1999) Complication, survival rates, and risk factors of surgery for metastatic disease of the spine. Spine 24:1943–1951CrossRef

41.

Gakhar H, Swamy GN, Bommireddy R, Calthorpe D, Klezl Z (2013) A study investigating the validity of modified Tokuhashi score to decide surgical intervention in patients with metastatic spinal cancer. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 22:565–568. https://doi.org/10.1007/s00586-012-2480-z CrossRef

42.

Hessler C, Vettorazzi E, Madert J, Bokemeyer C, Panse J (2011) Actual and predicted survival time of patients with spinal metastases of lung cancer: evaluation of the robustness of the Tokuhashi score. Spine 36:983–989. https://doi.org/10.1097/BRS.0b013e3181e8f7f8 CrossRefPubMed

43.

Tabouret E, Cauvin C, Fuentes S, Esterni B, Adetchessi T, Salem N, Madroszyk A, Gonçalves A, Casalonga F, Gravis G (2015) Reassessment of scoring systems and prognostic factors for metastatic spinal cord compression. Spine J Off J North Am Spine Soc 15:944–950. https://doi.org/10.1016/j.spinee.2013.06.036 CrossRef

Title: Outcomes of surgical treatments of spinal metastases: a prospective study
Authors: C. Bouthors
S. Prost
C. Court
B. Blondel
Y. P. Charles
S. Fuentes
H. P. Mousselard
C. Mazel
C. H. Flouzat-Lachaniette
P. Bonnevialle
F. Saihlan
the SOFCOT
Publication date: 01-05-2020
Publisher: Springer Berlin Heidelberg
Keyword: Metastasis
Published in: Supportive Care in Cancer / Issue 5/2020
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-019-05015-5

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Abstract

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Objective

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