Abstract
Background
It is common practice nowadays to treat patients with metastatic epidural spinal cord compression (MESCC) surgically. Extend and type of surgery should be in proper relation to the expected survival time of the patient. It is still difficult to predict patient's survival time and different scoring systems are used. Reliable prediction of survival is mandatory, in that way adjustable surgical treatment can be established.
Aim
Evaluating potential prognostic factors for survival after surgery for MESCC.
Methods
In this retrospective study we included 56 patients who underwent surgery for MESCC in two hospitals in the Netherlands between 2001 and 2007, Medical records were studied for the origin of the primary tumour, location of MESCC and the number of spots, presence of visceral or axial metastases, Karnofsky-score and ASA-score. Patients were grouped, according Tomita et al., for the localization of the primary tumour; fast (n=21), moderate (n=19) and slow (n=16) growing tumours. Survival times were compared with log-rank tests.
Results
The overall median survival after surgery was 7, 8 months (range: 0-69, 95% IV: 3, 2-12,2).
The origin of the primary tumour (p=0,001), presence of visceral metastases (p=0,017) and Karnofsky-score (p=0,033) were related to survival; other evaluated parameters were not. Patients within the fast group had a shorter median survival time (3, 5 months) than patients in the slow (32 months) and moderate group (15 months). Patients with visceral metastases survived shorter than patients without (5, 5 vs. 15 months). Patients with a baseline Karnofsky-score of 80% or higher had a longer survival time than patients with a lower score (11, 5 vs. 7, 8 months).
Conclusion
The origin of the primary tumour seems to be strongly associated with survival time, as are the presence of visceral metastases and the Karnofksy-score. A prediction model of spinal metastases should include these factors.
