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Chanplakorn P, Budsayavilaimas C, Jaipanya P, Pichyangkul P, Siriyotha S, Lertudomphonwanit T. Hematologic Malignancies Influence the Accuracy of Prediction of Survival in Patients With Solid Tumor Spinal Metastases Undergoing Surgery. JCO Glob Oncol 2024; 10:e2300419. [PMID: 38991185 DOI: 10.1200/go.23.00419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/28/2024] [Accepted: 04/30/2024] [Indexed: 07/13/2024] Open
Abstract
PURPOSE There is no consensus on how to identify patients with multiple-level spinal metastases who would benefit from surgery. Previous studies have revealed that patients with hematologic malignancies have a significantly longer median survival time than those with solid tumor spinal metastases. We aimed to compare predictors and survival data between patients with spinal metastases, including hematologic malignancies (all-malignancies group), with only those with nonhematologic malignancies (nonhematologic malignancies group). MATERIALS AND METHODS This single-center retrospective study included all patients age >18 years who underwent surgery to treat spinal metastases in our department from 2008 to 2018. The patients' baseline characteristics, treatment modalities, and laboratory results were analyzed. Survival was calculated from the date of surgery to the date of confirmed death. Cox regression analysis was used to identify independent predictors of survival. RESULTS The study cohort comprised 186 patients with a mean age of 57.1 ± 13.4 years, 101 of whom were male and 18 of whom had hematologic malignancies. The median survival time was 201 days in the all-malignancies group and 168 days in the nonhematologic malignancies group. Independent predictors of survival differed between the two groups. Eastern Cooperative Oncology Group status and response to preoperative chemotherapy were identified as independent factors in both groups. However, radiosensitivity and CNS metastases were identified only in the all-malignancies group, and tumor growth potential, albumin status, and number of vertebrae were identified only in the nonhematologic malignancies group. The receiver operating characteristics were comparable in the two groups: 0.75 in the all-malignancies group and 0.77 in the nonhematologic malignancies group. CONCLUSION Longer survival in patients with hematologic malignancies influences the overall prediction of survival. Tumor-specific prognostic factors may improve the prediction of survival in patients with spinal metastases.
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Affiliation(s)
- Pongsthorn Chanplakorn
- Department of Orthopaedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Pilan Jaipanya
- Chakri Naruebodindra Medical Institute, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
| | - Picharn Pichyangkul
- Chakri Naruebodindra Medical Institute, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
| | - Sukanya Siriyotha
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Thamrong Lertudomphonwanit
- Department of Orthopaedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Murotani K, Fujibayashi S, Otsuki B, Shimizu T, Sono T, Onishi E, Kimura H, Tamaki Y, Tsubouchi N, Ota M, Tsutsumi R, Ishibe T, Matsuda S. Prognostic Factors after Surgical Treatment for Spinal Metastases. Asian Spine J 2024; 18:390-397. [PMID: 38764228 PMCID: PMC11222892 DOI: 10.31616/asj.2023.0376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/01/2024] [Accepted: 02/16/2024] [Indexed: 05/21/2024] Open
Abstract
STUDY DESIGN A retrospective multicenter case series was conducted. PURPOSE This study aimed to investigate survival and prognostic factors after surgery for a metastatic spinal tumor. OVERVIEW OF LITERATURE Prognostic factors after spinal metastasis surgery remain controversial. METHODS A retrospective multicenter study was conducted. The study participants included 345 patients who underwent surgery for spinal metastases from 2010 to 2020 at nine referral spine centers in Japan. Data for each patient were extracted from medical records. To identify the factors predicting survival prognosis after surgery, univariate analyses were performed using a Cox proportional hazards model. RESULTS The mean age was 65.9 years. Common primary tumors were lung (n=72), prostate (n=61), and breast (n=39), and 67.8% (n=234) presented with osteolytic lesions. The epidural spinal cord compression scale score 2 or 3 was recognized in 79.0% (n=271). Frankel grade A paralysis accounted for 1.4% (n=5), and 73.3% (n=253) were categorized as intermediate or high risk according to the new Katagiri score. The overall survival rates were -71.0% at 6 months, 57.4% at 12, and 43.3% at 24. In the univariate analysis, Frankel grade A (hazard ratio [HR], 3.59; 95% confidence interval [CI], 1.23-10.50; p<0.05), intermediate risk (HR, 3.34; 95% CI, 2.10-5.32; p<0.01), and high risk (HR, 7.77; 95% CI, 4.72-12.8; p<0.01) in the new Katagiri score were significantly associated with poor survival. On the contrary, postoperative chemotherapy (HR, 0.23; 95% CI, 0.15-0.36; p<0.01), radiation therapy (HR, 0.43; 95% CI, 0.26-0.70; p<0.01), and both adjuvant therapy (HR, 0.21; 95% CI, 0.14-0.32; p<0.01) were suggested to improve survival. CONCLUSIONS Surgical indications for patients with Frankel grade A or intermediate or high risk in the new Katagiri score should be carefully considered because of poor survival. Chemotherapy or radiation therapy should be considered after surgery for better survival.
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Affiliation(s)
- Kazuhiro Murotani
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shunsuke Fujibayashi
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Bungo Otsuki
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takayoshi Shimizu
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Sono
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Eijiro Onishi
- Department of Orthopaedic Surgery, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Hiroaki Kimura
- Department of Orthopaedic Surgery, Amagasaki General Medical Center, Hyogo, Japan
| | - Yasuyuki Tamaki
- Department of Orthopaedic Surgery, Wakayama Red Cross Hospital, Wakayama, Japan
| | - Naoya Tsubouchi
- Department of Orthopaedic Surgery, Kyoto Medical Center, Kyoto, Japan
| | - Masato Ota
- Department of Orthopaedic Surgery, Kitano Hospital, Osaka, Japan
| | - Ryosuke Tsutsumi
- Department of Orthopaedic Surgery, Osaka Red-Cross Hospital, Osaka, Japan
| | - Tatsuya Ishibe
- Shiga Spine Center, Hino Memorial Hospital, Shiga, Japan
| | - Shuichi Matsuda
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Chanplakorn P, Budsayavilaimas C, Jaipanya P, Kraiwattanapong C, Keorochana G, Leelapattana P, Lertudomphonwanit T. Validation of Traditional Prognosis Scoring Systems and Skeletal Oncology Research Group Nomogram for Predicting Survival of Spinal Metastasis Patients Undergoing Surgery. Clin Orthop Surg 2022; 14:548-556. [PMID: 36518924 PMCID: PMC9715924 DOI: 10.4055/cios22014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/13/2022] [Accepted: 04/16/2022] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Many scoring systems that predict overall patient survival are based on clinical parameters and primary tumor type. To date, no consensus exists regarding which scoring system has the greatest predictive survival accuracy, especially when applied to specific primary tumors. Additionally, such scores usually fail to include modern treatment modalities, which influence patient survival. This study aimed to evaluate both the overall predictive accuracy of such scoring systems and the predictive accuracy based on the primary tumor. METHODS A retrospective review on spinal metastasis patients who were aged more than 18 years and underwent surgical treatment was conducted between October 2008 and August 2018. Patients were scored based on data before the time of surgery. A survival probability was calculated for each patient using the given scoring systems. The predictive ability of each scoring system was assessed using receiver operating characteristic analysis at postoperative time points; area under the curve was then calculated to quantify predictive accuracy. RESULTS A total of 186 patients were included in this analysis: 101 (54.3%) were men and the mean age was 57.1 years. Primary tumors were lung in 37 (20%), breast in 26 (14%), prostate in 20 (10.8%), hematologic malignancy in 18 (9.7%), thyroid in 10 (5.4%), gastrointestinal tumor in 25 (13.4%), and others in 40 (21.5%). The primary tumor was unidentified in 10 patients (5.3%). The overall survival was 201 days. For survival prediction, the Skeletal Oncology Research Group (SORG) nomogram showed the highest performance when compared to other prognosis scores in all tumor metastasis but a lower performance to predict survival with lung cancer. The revised Katagiri score demonstrated acceptable performance to predict death for breast cancer metastasis. The Tomita and revised Tokuhashi scores revealed acceptable performance in lung cancer metastasis. The New England Spinal Metastasis Score showed acceptable performance for predicting death in prostate cancer metastasis. SORG nomogram demonstrated acceptable performance for predicting death in hematologic malignancy metastasis at all time points. CONCLUSIONS The results of this study demonstrated inconsistent predictive performance among the prediction models for the specific primary tumor types. The SORG nomogram revealed the highest predictive performance when compared to previous survival prediction models.
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Affiliation(s)
- Pongsthorn Chanplakorn
- Department of Orthopedic, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chanthong Budsayavilaimas
- Department of Orthopedic, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Orthopedic Unit, Banphaeo General Hospital, Samutsakhon, Thailand
| | - Pilan Jaipanya
- Department of Orthopedic, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Orthopedic Unit, Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
| | - Chaiwat Kraiwattanapong
- Department of Orthopedic, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Gun Keorochana
- Department of Orthopedic, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pittavat Leelapattana
- Department of Orthopedic, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Thamrong Lertudomphonwanit
- Department of Orthopedic, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Nakajima H, Watanabe S, Honjoh K, Izubuchi Y, Watanabe Y, Tanaka T, Matsumine A. Prognosis after Palliative Surgery for Patients with Spinal Metastasis: Comparison of Predicted and Actual Survival. Cancers (Basel) 2022; 14:cancers14163868. [PMID: 36010862 PMCID: PMC9405944 DOI: 10.3390/cancers14163868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/28/2022] [Accepted: 08/08/2022] [Indexed: 11/18/2022] Open
Abstract
Simple Summary Increased options for cancer treatment have made the prediction of prognosis an important factor in therapeutic decision making. The aim of this study was to assess the clinical significance of prognosis–scoring systems and to identify predictors for 6–month mortality after palliative surgery. The median actual survival period was longer than the predicted life expectancy based on the revised Tokuhashi score and new Katagiri score. However, 21.3% of patients died of cancers within 6 months after palliative surgery. A statistical analysis showed that a higher CRP/albumin ratio (odds ratio: 0.39; cut–off 0.409) and absence of postoperative adjuvant therapy (odds ratio: 7.15) were independent risk factors for poor survival. Our findings suggest the need for careful consideration to determine if palliative surgery is the best option for a patient with these negative prognostic factors, regardless of life expectancy predicted based on a prognosis score. Abstract Prediction of prognosis is a key factor in therapeutic decision making due to recent the development of therapeutic options for spinal metastases. The aim of the study was to examine predictive scoring systems and identify prognostic factors for 6–month mortality after palliative surgery. The participants were 75 patients with spinal metastases who underwent palliative surgery and had a minimum follow–up period of 1 year. Associations of actual survival with categories based on the revised Tokuhashi score and new Katagiri score were evaluated. Univariate and multivariate analyses were performed to identify prognostic factors for 6–month mortality after palliative surgery. The median actual survival period was longer than those predicted using the scoring systems. However, 21.3% of patients died of cancers within 6 months after surgery. A higher CRP/albumin ratio (odds ratio: 0.39; cut–off 0.409) and absence of postoperative adjuvant therapy (odds ratio: 7.15) were independent risk factors for 6–month mortality. There was no association of mortality with primary site, severity of sarcopenia, or other biomarkers. These results suggest that careful consideration is needed to determine whether palliative surgery is the best option for patients with a high preoperative CRP/albumin ratio and/or absence of postoperative adjuvant therapy, regardless of predictions made from scoring systems.
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Jaipanya P, Chanplakorn P. Prolonged durability of extensive contiguous spinal metastasis stabilization in non-small cell lung cancer patients receiving targeted therapy: two case reports and a literature review. J Int Med Res 2022; 50:3000605221105003. [PMID: 35681249 PMCID: PMC9189544 DOI: 10.1177/03000605221105003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Contiguous spinal metastasis poses a challenge for spine surgeons. In patients with a short remaining life expectancy, surgery may be discouraged. However, in select cases, surgery may be inevitable to eliminate pain and improve the patient’s quality of life. Additionally, with advancements in systemic cancer therapy, the efficacy and duration of tumor control have improved significantly. Consequently, a patient’s life expectancy may be difficult to estimate with existing prognostic scores. Because patients may achieve prolonged survival, spinal metastasis surgery could greatly benefit a patient’s quality of life. In this report, we present the details of two patients with non-small lung cancer with contiguous spinal metastasis who underwent spinal surgery for their metastatic disease. After surgery and targeted therapy with epidermal growth factor tyrosine kinase inhibitors (EGFR TKI), the patients attained substantial healing of their previously lytic spines and achieved prolonged survival of up to 42 months. With modern systemic therapy for lung cancer, the treatment of spinal metastatic disease can achieve decent outcomes, even in poor surgical candidates.
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Affiliation(s)
- Pilan Jaipanya
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 111 Suwannabhumi Canal Road, Bang Pla, Bang Phli District, Samut Prakan 10540, Thailand
| | - Pongsthorn Chanplakorn
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270, Rama VI Road, Thung Phaya Thai, Ratchathewi District, Bangkok 10400, Thailand
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Schoenfeld AJ, Ferrone ML, Blucher JA, Agaronnik N, Nguyen L, Tobert DG, Balboni TA, Schwab JH, Shin JH, Sciubba DM, Harris MB. Prospective comparison of the accuracy of the New England Spinal Metastasis Score (NESMS) to legacy scoring systems in prognosticating outcomes following treatment of spinal metastases. Spine J 2022; 22:39-48. [PMID: 33741509 PMCID: PMC8443703 DOI: 10.1016/j.spinee.2021.03.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/16/2021] [Accepted: 03/08/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT We developed the New England Spinal Metastasis Score (NESMS) as a simple, informative, scoring scheme that could be applied to both operative and non-operative patients. The performance of the NESMS to other legacy scoring systems has not previously been compared using appropriately powered, prospectively collected, longitudinal data. PURPOSE To compare the predictive capacity of the NESMS to the Tokuhashi, Tomita and Spinal Instability Neoplastic Score (SINS) in a prospective cohort, where all scores were assigned at the time of baseline enrollment. PATIENT SAMPLE We enrolled 202 patients with spinal metastases who met inclusion criteria between 2017-2019. OUTCOME MEASURES One-year survival (primary); 3-month mortality and ambulatory function at 3- and 6-months were considered secondarily. METHODS All prognostic scores were assigned based on enrollment data, which was also assigned as time-zero. Patients were followed until death or survival at 365 days after enrollment. Survival was assessed using Kaplan-Meier curves and score performance was determined via logistic regression testing and observed to expected plots. The discriminative capacity (c-statistic) of the scoring measures were compared via the z-score. RESULTS When comparing the discriminative capacity of the predictive scores, the NESMS had the highest c-statistic (0.79), followed by the Tomita (0.69), the Tokuhashi (0.67) and the SINS (0.54). The discriminative capacity of the NESMS was significantly greater (p-value range: 0.02 to <0.001) than any of the other predictive tools. The NESMS was also able to inform independent ambulatory function at 3- and 6-months, a function that was only uniformly replicated by the Tokuhashi score. CONCLUSIONS The results of this prospective validation study indicate that the NESMS was able to differentiate survival to a significantly higher degree than the Tokuhashi, Tomita and SINS. We believe that these findings endorse the utilization of the NESMS as a prognostic tool capable of informing care for patients with spinal metastases.
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Affiliation(s)
- Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
| | - Marco L Ferrone
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Justin A Blucher
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Nicole Agaronnik
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Lananh Nguyen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Daniel G Tobert
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Tracy A Balboni
- Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Joseph H Schwab
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - Mitchel B Harris
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
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Robotic-assisted percutaneous iliac screw fixation for destructive lumbosacral metastatic lesions: an early single-institution experience. Acta Neurochir (Wien) 2021; 163:2983-2990. [PMID: 34129101 DOI: 10.1007/s00701-021-04894-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/24/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Robotic-assisted surgery is becoming more widely applied in surgical subspecialties due to its intraoperative and postoperative advantages such as minimally invasive approach, reduced blood loss, shorter hospital stay, and decreased incidence of postoperative complications. However, robotic devices were only recently introduced in the field of spinal surgery. Specifically, percutaneous approaches involving computer-assisted image guidance are relatively new in iliac screw fixation. Previous methods focused on the use of S2-alar-iliac (S2AI) screw fixation which allows for pelvic fixation without a need for side connectors. However, for patients with destructive lesions of the sacrum, placement of these S2AI screws may not be feasible. The purpose of this technical note is to illustrate the implementation of robotic-assisted percutaneous iliac screw fixation in two cases which allows for minimally invasive attachment to the proximal lumbar screws without a side connector and eliminates a potential source of instrumentation failure. METHODS Robotic-assisted percutaneous iliac screw fixation was performed on two patients. The robotics system was used to merge the fluoroscopic images with intraoperative computed tomography (CT) images to plan the trajectories for placement of bilateral pedicle and iliac screws. Intraoperative CT scan was again performed to confirm proper placement of all screws. Rods were then engaged bilaterally with the pedicle and iliac screws without the use of side connectors. RESULTS The patients did not experience immediate postoperative complications and had stable hardware at one-month follow-up. Our cases demonstrate the surgical efficiency of robotic-assisted lumbo-iliac instrumentation which obviates the need to use a side connector, which is commonly used in iliac fixation. This eliminates a step, which can reduce the possibility of instrumentation failure. CONCLUSION Robotic-assisted percutaneous iliac screw fixation is a safe and feasible technique to improve operative and clinical outcomes in complex spinal instrumentation surgeries.
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Young MJ, Regenhardt RW, Sokol LL, Leslie-Mazwi TM. When Should Neuroendovascular Care for Patients With Acute Stroke Be Palliative? AMA J Ethics 2021; 23:E783-793. [PMID: 34859772 PMCID: PMC8684539 DOI: 10.1001/amajethics.2021.783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Noncurative surgeries intended to relieve suffering during serious illness or near end of life have been analyzed across palliative settings. Yet sparse guidance is available to inform clinical management decisions about whether, when, and which interventions should be offered when ischemic stroke and other neurological complications occur in patients whose survival is extended by other novel disease-modifying interventions. This case commentary examines key ethical and clinical considerations in palliative neuroendovascular care of patients with acute stroke.
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Affiliation(s)
- Michael J Young
- Fellow in neurology at Massachusetts General Hospital and Brigham and Women's Hospital in Boston
| | - Robert W Regenhardt
- Neuroendovascular fellow and stroke scientist at Massachusetts General Hospital in Boston
| | - Leonard L Sokol
- Neurology resident physician at Northwestern University in Evanston, Illinois
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Dhamija B, Batheja D, Balain BS. A systematic review of MIS and open decompression surgery for spinal metastases in the last two decades. J Clin Orthop Trauma 2021; 22:101596. [PMID: 34631409 PMCID: PMC8488238 DOI: 10.1016/j.jcot.2021.101596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The primary intention of this review being to produce an updated systematic review of the literature on published outcomes of decompressive surgery for metastatic spinal disease including metastatic spinal cord compression, using techniques of MIS and open decompressive surgery. METHODS The authors conducted database searches of OVID MEDLINE and EMBASE identifying those studies that reported clinical outcomes, surgical techniques used along with associated complications when decompressive surgery was employed for metastatic spinal tumors. Both retrospective and prospective studies were analysed. Articles were assessed to ensure the required inclusion criteria was met. Articles were then categorised and tabulated based on the following reported outcomes: predictors of survival, predictors of ambulation or motor function, surgical technique, neurological function, and miscellaneous outcomes. RESULTS 2654 citations were retrieved from databases, of these 31 met the inclusion criteria. 5 studies were prospective, the remaining 26 were retrospective. Publication years ranged from 2000 to 2020. Study size ranged from 30 to 914 patients. The most common primary tumors identified were lungs, breast, prostate and renal cancers. One study ( Lo and Yang, 2017)13 reported that in those patients with motor deficit, survival was significantly improved when surgery was performed within 7 days of the development of motor deficit compared to situations when surgery was carried out 7 days after onset. This was the only study that showed that the timing of surgery plays a significant role w.r.t. survival following the onset of spinal cord compression symptoms. Four articles identified that a pre-operative intact motor function and or ambulatory status conferred a higher likelihood of a better post-operative outcome, not just in relation to survival but also in relation to post-operative ambulation as well as a greater tendency towards suitability for adjuvant treatment. Even for the same scoring system e.g. tokuhashi and its effectiveness in predicting survival, results from different studies varied in their outcome. The Karnofsky Performance Status (KPS) being the most commonly used tool to assess functional impairment, the Eastern Cooperative Oncology Group (ECOG) performance status being used in two studies. 23 studies identified an improvement in neurological function following surgery. The most common functional scale used to assess neurological outcome was the Frankel scale, 3 studies used the American Spinal Injury Association (ASIA) impairment scale for this purpose. Wound problems including infection and dehiscence appeared to be the most commonly reported surgical complication. (25 studies). The most commonly used surgical technique involved a posterior approach with decompression, with or without stabilisation. Less commonly employed techniques included percutaneous pedicle screw fixation associated with or without mini-decompression as well as anterior approaches involving corpectomy and instrumentation. 9 studies included in their data, the effect of radiation therapy in combination with surgery or as a comparison used as an alternative to surgery in spinal metastases. CONCLUSIONS We provide a systematic literature review on the outcomes of decompressive surgery for spinal metastases. We analyse survival data, motor function, neurological function, as well as the techniques of surgery used. Where appropriate complications of surgery are also highlighted. It is the authors' intention to provide the reader with a reference text where this information is ready to hand, allowing for the consideration of means and methods to improve and optimise the standard of care in patients undergoing surgical intervention for metastatic spinal disease.
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Zhou J, Xu S, Cao Z, Tang J, Fang X, Qin L, Zhou F, He Y, Zhong X, Hu M, Wang Y, Lu F, Bao Y, Dai X, Wu Q. Validation of the Palliative Prognostic Index, Performance Status-Based Palliative Prognostic Index and Chinese Prognostic Scale in a home palliative care setting for patients with advanced cancer in China. BMC Palliat Care 2020; 19:167. [PMID: 33129305 PMCID: PMC7603699 DOI: 10.1186/s12904-020-00676-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 10/22/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The predictive value of the prognostic tool for patients with advanced cancer is uncertain in mainland China, especially in the home-based palliative care (HPC) setting. This study aimed to compare the accuracy of the Palliative Prognostic Index (PPI), the Performance Status-Based Palliative Prognostic Index (PS-PPI), and the Chinese Prognosis Scale (ChPS) for patients with advanced cancer in the HPC setting in mainland China. METHODS Patients with advanced cancer admitted to the hospice center of Yuebei People's Hospital between January 2014 and December 2018 were retrospectively calculated the scores according to the three prognostic tools. The Kaplan-Meier method was used to compare survival times among different risk groups. Receiver operating characteristic curve analysis was used to assess the predictive value. The accuracy of 21-, 42- and 90-day survival was compared among the three prognostic tools. RESULTS A total of 1863 patients were included. Survival time among the risk groups of all prognostic tools was significantly different from each other except for the PPI. The AUROC of the ChPS was significantly higher than that of the PPI and PS-PPI for 7-, 14, 21-, 42-, 90-, 120-, 150- and 180-day survival (P < 0.05). The AUROC of the PPI and PS-PPI were not significantly different from each other (P > 0.05). CONCLUSIONS The ChPS is more suitable than the PPI and PS-PPI for advanced cancer patients in the HPC setting. More researches are needed to verify the predictive value of the ChPS, PPI, and PS-PPI in the HPC setting in the future.
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Affiliation(s)
- Jun Zhou
- Department of Spine Surgery, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Sitao Xu
- Department of Spine Surgery, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Ziye Cao
- Department of Spine Surgery, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Jing Tang
- Department of Spine Surgery, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Xiang Fang
- Department of Spine Surgery, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Ling Qin
- Department of Spine Surgery, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Fangping Zhou
- Department of Nursing, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Yuzhen He
- Department of Nursing, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
- Hospice center of Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Xueren Zhong
- Department of Spine Surgery, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Mingcai Hu
- Hospice center of Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Yan Wang
- Emergency rescue command center of Shaoguan city, Shaoguan, Guangdong China
| | - Fengjuan Lu
- Hospice center of Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi China
| | - Yongzheng Bao
- Department of Spine Surgery, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
| | - Xiangheng Dai
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong China
| | - Qiang Wu
- Department of Spine Surgery, Yuebei People’s Hospital Affiliated to Shantou University Medical College, Shaoguan, Guangdong China
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