Back to Search
Start Over
Characteristics of Patients Who Survived <3 Months or > 2 Years After Surgery for Spinal Metastases: Can We Avoid Inappropriate Patient Selection?
- Source :
- Journal of Clinical Oncology, 34(25), 3054-3061. AMER SOC CLINICAL ONCOLOGY, Journal of Clinical Oncology, 34(25), 3054-+. AMER SOC CLINICAL ONCOLOGY, Journal of Clinical Oncology, 34(25), 3054. American Society of Clinical Oncology
- Publication Year :
- 2016
-
Abstract
- 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
Details
- Language :
- English
- ISSN :
- 0732183X
- Database :
- OpenAIRE
- Journal :
- Journal of Clinical Oncology, 34(25), 3054-3061. AMER SOC CLINICAL ONCOLOGY, Journal of Clinical Oncology, 34(25), 3054-+. AMER SOC CLINICAL ONCOLOGY, Journal of Clinical Oncology, 34(25), 3054. American Society of Clinical Oncology
- Accession number :
- edsair.dedup.wf.001..10ff23e985098c5a99cc5c8eb0e07361