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Truong VT, Al-Shakfa F, Roberge D, Masucci GL, Tran TPY, Dib R, Yuh SJ, Wang Z. Assessing the Performance of Prognostic Scores in Patients with Spinal Metastases from Lung Cancer Undergoing Non-surgical Treatment. Asian Spine J 2023; 17:739-749. [PMID: 37408290 PMCID: PMC10460656 DOI: 10.31616/asj.2022.0377] [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: 11/01/2022] [Revised: 01/06/2023] [Accepted: 02/13/2023] [Indexed: 07/07/2023] Open
Abstract
STUDY DESIGN Retrospective study. PURPOSE The purpose of this study was to see how well the Tomita score, revised Tokuhashi score, modified Bauer score, Van der Linden score, classic Skeletal Oncology Research Group (SORG) algorithm, SORG nomogram, and New England Spinal Metastasis Score (NESMS) predicted 3-month, 6-month, and 1-year survival of non-surgical lung cancer spinal metastases. OVERVIEW OF LITERATURE There has been no study assessing the performance of prognostic scores for non-surgical lung cancer spinal metastases. METHODS Data analysis was carried out to identify the variables that had a significant impact on survival. For all patients with spinal metastasis from lung cancer who received non-surgical treatment, the Tomita score, revised Tokuhashi score, modified Bauer score, Van der Linden score, classic SORG algorithm, SORG nomogram, and NESMS were calculated. The performance of the scoring systems was assessed by using receiver operating characteristic (ROC) curves at 3 months, 6 months, and 12 months. The predictive accuracy of the scoring systems was quantified using the area under the ROC curve (AUC). RESULTS A total of 127 patients are included in the present study. The median survival of the population study was 5.3 months (95% confidence interval [CI], 3.7-9.6 months). Low hemoglobin was associated with shorter survival (hazard ratio [HR], 1.49; 95% CI, 1.00-2.23; p =0.049), while targeted therapy after spinal metastasis was associated with longer survival (HR, 0.34; 95% CI, 0.21-0.51; p <0.001). In the multivariate analysis, targeted therapy was independently associated with longer survival (HR, 0.3; 95% CI, 0.17-0.5; p <0.001). The AUC of the time-dependent ROC curves for the above prognostic scores revealed all of them performed poorly (AUC <0.7). CONCLUSIONS The seven scoring systems investigated are ineffective at predicting survival in patients with spinal metastasis from lung cancer who are treated non-surgically.
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Affiliation(s)
- Van Tri Truong
- Division of Orthopaedics, Centre Hospitalier de l’Université de Montréal (CHUM), University of Montreal, Montreal, QC,
Canada
- Department of Neurosurgery, Vinmec Central Park International Hospital, Vinmec Healthcare System, Ho Chi Minh City,
Vietnam
| | - Fidaa Al-Shakfa
- Division of Orthopaedics, Centre Hospitalier de l’Université de Montréal (CHUM), University of Montreal, Montreal, QC,
Canada
| | - David Roberge
- Division of Radiation Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), University of Montreal, Montreal, QC,
Canada
| | - Giuseppina Laura Masucci
- Division of Radiation Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), University of Montreal, Montreal, QC,
Canada
| | - Thi Phuoc Yen Tran
- Research Center, Centre Hospitalier de l’Université de Montréal (CHUM), University of Montreal, Montreal, QC,
Canada
- Department of Internal Medicine, Vinmec Central Park International Hospital, Vinmec Healthcare System, Ho Chi Minh City,
Vietnam
| | - Rama Dib
- Division of Orthopaedics, Centre Hospitalier de l’Université de Montréal (CHUM), University of Montreal, Montreal, QC,
Canada
| | - Sung-Joo Yuh
- Division of Neurosurgery, Centre Hospitalier de l’Université de Montréal (CHUM), University of Montreal, Montreal, QC,
Canada
| | - Zhi Wang
- Division of Orthopaedics, Centre Hospitalier de l’Université de Montréal (CHUM), University of Montreal, Montreal, QC,
Canada
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Prognostic factors and outcomes of surgical intervention for patients with spinal metastases secondary to lung cancer: an update systematic review and meta analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:228-243. [PMID: 36372842 PMCID: PMC9660217 DOI: 10.1007/s00586-022-07444-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 09/07/2022] [Accepted: 10/31/2022] [Indexed: 11/15/2022]
Abstract
PURPOSE Lung cancer is one of the most common malignant tumors. Most patients develop spinal metastases during the course of cancer and suffer skeletal-related events. Currently, no consensus has been reached on the prognostic factors in patients undergoing surgeries. This study aimed to answer two questions: (1) what are the effects of surgical intervention, and (2) what are the factors associated with postoperative survival. METHODS Searches were performed on electronic databases including PubMed, Ovid/MEDLINE, Cochrane, and Scopus for articles published before February of 2022, involving the survival factors of patients with spinal metastasis. Multiple data items were considered, such as baseline demographics, surgical details, clinical outcome, and prognostic factors. The analysis was performed in Review Manager (RevMan) 5.5. The prognostic factors of survival were analyzed with univariate and multivariate cox regression analysis. RESULTS Finally, 14 studies with 813 patients were identified. Their 6, 12, and 24 months survival rates ranged from 18 to 58%, 18 to 22.4%, and 0 to 58.5%, respectively. The pooled hazard ratio of preoperative ambulatory status and the number of involved vertebrae demonstrated statistical significance, while no significant prognostic effect on the overall survival was found for targeted therapy, visceral metastases, chemotherapy, radiotherapy, or postoperative ambulatory status. CONCLUSION Overall, surgical intervention could achieve significant pain relief and neurological function improvements. For patients receiving surgery for spinal metastasis from lung cancer, preoperative ambulatory status and the number of involved vertebrae were significant prognostic factors associated with their survival.
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Dobran M, Lisi SV, Di Rienzo A, Carrassi E, Capece M, Dorato P, di Somma LGM, Iacoangeli M. Evaluation of prognostic preoperative factors in patients undergoing surgery for spinal metastases: Results in a consecutive series of 81 cases. Surg Neurol Int 2022; 13:363. [PMID: 36128147 PMCID: PMC9479529 DOI: 10.25259/sni_276_2022] [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: 03/21/2022] [Accepted: 07/06/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Surgical treatment of spinal metastases should be tailored to provide pain control, neurological deficit improvement, and vertebral stability with low operative morbidity and mortality. The aim of this study was to analyze the predictive value of some preoperative factors on overall survival in patients undergoing surgery for spinal metastases. Methods: We retrospectively analyzed a consecutive series of 81 patients who underwent surgery for spinal metastases from 2015 and 2021 in the Clinic of Neurosurgery of Ancona (Italy). Data regarding patients’ baseline characteristics, preoperative Karnofsky Performance Status Score (KPS), and Frankel classification grading system, histology of primary tumor, Tokuhashi revised and Tomita scores, Spine Instability Neoplastic Score, and Epidural Spinal Cord Compression Classification were collected. We also evaluated the interval time between the diagnosis of the primary tumor and the onset of spinal metastasis, the type of surgery, the administration of adjuvant therapy, postoperative pain and Frankel grade, and complications after surgery. The relationship between patients’ overall survival and predictive preoperative factors was analyzed by the Kaplan–Meier method. For the univariate and multivariate analysis, the log-rank test and Cox regression model were used. P ≤ 0.05 was considered as statistically significant. Results: After surgery, the median survival time was 13 months. In our series, the histology of the primary tumor (P < 0.001), the Tomita (P < 0.001) and the Tokuhashi revised scores (P < 0.001), the preoperative KPS (P < 0.001), the adjuvant therapy (P < 0.001), the postoperative Frankel grade (P < 0.001), and the postoperative pain improvement (P < 0.001) were significantly related to overall survival in the univariate analysis. In the multivariate analysis, the Tomita (P < 0.001), Tokuhashi revised scores (P < 0.001), and the adjuvant therapy were confirmed as independent prognostic factors. Conclusion: These data suggest that patients with limited extension of primitive tumor and responsive to the adjuvant therapy are the best candidates for surgery with better outcome.
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Systemic considerations for the surgical treatment of spinal metastatic disease: a scoping literature review. Lancet Oncol 2022; 23:e321-e333. [PMID: 35772464 PMCID: PMC9844540 DOI: 10.1016/s1470-2045(22)00126-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/03/2022] [Accepted: 02/22/2022] [Indexed: 01/19/2023]
Abstract
Systemic assessment is a pillar in the neurological, oncological, mechanical, and systemic (NOMS) decision-making framework for the treatment of patients with spinal metastatic disease. Despite this importance, emerging evidence relating systemic considerations to clinical outcomes following surgery for spinal metastatic disease has not been comprehensively summarised. We aimed to conduct a scoping literature review of this broad topic. We searched MEDLINE, Embase, Scopus, Cochrane Central Register of Controlled Trials, Web of Science, and CINAHL databases from Jan 1, 2000, to July 31, 2021. 61 articles were included, accounting for a total of 22 335 patients. Preoperative systemic variables negatively associated with postoperative clinical outcomes included demographics (eg, older age [>60 years], Black race, male sex, low or elevated body-mass index, and smoking status), medical comorbidities (eg, cardiac, pulmonary, hepatic, renal, endocrine, vascular, and rheumatological), biochemical abnormalities (eg, hypoalbuminaemia, atypical blood cell counts, and elevated C-reactive protein concentration), low muscle mass, generalised motor weakness (American Spinal Cord Injury Association Impairment Scale grade and Frankel grade) and poor ambulation, reduced performance status, and systemic disease burden. This is the first comprehensive scoping review to broadly summarise emerging evidence relevant to the systemic assessment component of the widely used NOMS framework for spinal metastatic disease decision making. Medical, surgical, and radiation oncologists can consider these findings when prognosticating spinal metastatic disease-related surgical outcomes on the basis of patients' systemic condition. These factors might inform a shared decision-making approach with patients and their families.
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Truong VT, Al-Shakfa F, Phan P, Newman N, Boubez G, Shedid D, Yuh SJ, Wang Z. Does the Region of the Spine Involved with Metastatic Tumor Affect Outcomes of Surgical Treatments? World Neurosurg 2021; 156:e139-e151. [PMID: 34530150 DOI: 10.1016/j.wneu.2021.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Spinal metastases occur primarily in the thoracic spine (50%-60%), less commonly in the lumbar (30%-35%), and, infrequently, in the cervical spine (10%-15%). There has been only 1 study with a limited population comparing the postoperative outcome among cervical, thoracic, and lumbar spine metastasis. The aim of this study is to identify whether the region of surgically treated spinal metastasis affects postoperative outcomes. METHODS A retrospective study of patients with spinal metastasis was performed. The collected data were as follows: age, gender, smoking history, tumor histology, revised Tokuhashi score, preoperative and postoperative American Spinal Injury Association score, region of spinal metastasis, ambulatory status, surgical approach, surgery time, blood loss, complications, length of hospital stay, postoperative pain relief, postoperative adjuvant therapy, and survival. Data were analyzed to identify the factors affecting the survival and postoperative functional outcome. RESULTS We studied 191 patients with spinal metastasis including 47 cervical spine metastases, 96 thoracic spine metastases, and 48 lumbar spine metastases, with a mean age of 60.91 ± 9.72 years. The overall median survival was 7 months (95% confidence interval, 2.9-20.63 months). Univariate analysis showed that region of the spine involved with metastasis did not significantly affect the survival and postoperative motor function improvement. Multivariate analysis showed that revised Tokuhashi score, postoperative radiotherapy, and postoperative chemotherapy were independent factors affecting survival. The rate of 30-day complications among patients with different regions of spine metastasis did not reach significance. CONCLUSIONS The postoperative outcomes of patients undergoing surgery for metastases are not affected by the region of the spine.
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Affiliation(s)
- Van Tri Truong
- Division of Orthopedics, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada.
| | - Fidaa Al-Shakfa
- Division of Orthopedics, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - Philippe Phan
- Division of Orthopedics, Ottawa Hospital-Civic Campus, Ottawa, Ontario, Canada
| | - Nicholas Newman
- Division of Orthopedics, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - Ghassan Boubez
- Division of Orthopedics, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - Daniel Shedid
- Division of Neurosurgery, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - Sung-Joo Yuh
- Division of Neurosurgery, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - Zhi Wang
- Division of Orthopedics, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
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Surgical Intervention for Patients With Spinal Metastasis From Lung Cancer: A Retrospective Study of 87 Cases. Clin Spine Surg 2021; 34:E133-E140. [PMID: 32868534 DOI: 10.1097/bsd.0000000000001062] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 07/24/2020] [Indexed: 12/21/2022]
Abstract
STUDY DESIGN This was a retrospective study. OBJECTIVE Evaluate the prognosis and surgical outcomes of patients with spinal metastasis from lung cancer undergoing surgical treatment. SUMMARY OF BACKGROUND DATA The spine is the most common site of metastatic lesions in patients with lung cancer. There have been a few studies, all small cohorts studying prognosis and surgical outcomes and the results were discordant. MATERIALS AND METHODS A retrospective study on a prospectively collected database was conducted. Data collected were the following: age, tobacco use, tumor histology, American Spinal Injury Association score, revised Tokuhashi score, ambulatory status, perioperative complications, postoperative adjuvant treatment, and survival time. Univariate and multivariate analyses were performed to identify the prognostic factors of survival. RESULTS The authors studied 87 patients with a mean age of 61.3±1.9 years. Median survival was 4.1±0.8 months. Twenty-eight patients (32.2%) lived >6 months and 14 patients (16.1%) lived >12 months. The medical complication rate was 13.8% and the surgical complication rate was 5.7%. The 30-day mortality rate was 4.6%. Univariate analysis showed tobacco use, revised Tokuhashi score, preoperative and postoperative American Spinal Injury Association score, postoperative walking ability, postoperative radiotherapy, and postoperative chemotherapy were prognostic factors. There was no significant difference in survival between adenoma lung cancers, nonadenoma lung cancers, and small cell lung cancers (P=0.51). Multivariate analysis revealed tobacco use, revised Tokuhashi score, postoperative walking ability, postoperative radiotherapy, and postoperative chemotherapy affected the survival. CONCLUSIONS This is the largest reported study of patients with spinal metastasis from lung cancer undergoing spinal surgery. It is the first study showing that tobacco use has a negative impact on survival. Spinal surgery improves the quality of life and offers nonambulatory patients a high chance of regaining walking ability with an acceptable risk of complications.
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Gao ZY, Zhang T, Zhang H, Pang CG, Jiang WX. Establishment and validation of nomogram model for survival predicting in patients with spinal metastases secondary to lung cancer. Neurol Res 2020; 43:327-335. [PMID: 33377432 DOI: 10.1080/01616412.2020.1866244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To evaluate the prognostic effect of pre-treatment factors in patients with spinal metastases secondary to lung cancer, and establish a novel predicting nomogram for predicting the survival probability. METHODS A total of 209 patients operated for spinal metastases from lung cancer were consecutively enrolled, and divided into the training and validation samples with a ratio of 7:3, for model establishing and validating, respectively. Basing on the training sample, univariate and multivariate COX proportional hazard models were used for identifying the prognostic effect of pre-treatment factors, following which significant prognostic factors would be listed as items in nomogram to calculate the survival probabilities at 3, 6, 12 and 18 months. Then, the C-indexes and the calibration curves would be figured out to evaluate the discrimination ability and accuracy of the model both for the training and validation samples. RESULTS In the multivariate COX analysis, the gender, smoking history, location of spinal metastasis, visceral metastasis, Karnofsky performance status (KPS), adjuvant therapy, lymphocyte percentage and globulin were found to be significantly associated with the overall survival, and a novel nomogram was generated basing on these independent predictors. The C-indexes for the training and validation samples were 0.761 and 0.732, respectively. Favorable consistencies between the predicted and actual survival rates were demonstrated both in the internal and external validations. DISCUSSION Pre-treatment characteristics, including gender, smoking history, location of spinal metastasis, visceral metastasis, KPS, adjuvant therapy, percentage of lymphocyte, and serum globulin level, were identified to be significantly associated with overall survival of patients living with spinal metastases derived from lung cancer, and a user-friendly nomogram was established using these independent predictors.
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Affiliation(s)
- Zhong-Yu Gao
- Department of Orthopedic Surgery, Tianjin First Central Hospital, Tianjin, China
| | - Tao Zhang
- Department of Orthopedic Surgery, Tianjin First Central Hospital, Tianjin, China
| | - Hui Zhang
- Department of Orthopedic Surgery, Tianjin First Central Hospital, Tianjin, China
| | | | - Wen-Xue Jiang
- Department of Orthopedic Surgery, Tianjin First Central Hospital, Tianjin, China
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Miura K, Koda M, Abe T, Kono M, Eto F, Kumagai H, Nagashima K, Fujii K, Noguchi H, Funayama T, Yamazaki M. Comparison of clinical results of decompression/fusion surgery for paralysis caused by metastatic spinal tumors of unknown versus known origin. J Rural Med 2020; 15:189-193. [PMID: 33033540 PMCID: PMC7530598 DOI: 10.2185/jrm.2020-031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/16/2020] [Indexed: 12/03/2022] Open
Abstract
Objective: Whether or not emergent decompression/fusion surgery for
paralysis caused by metastatic spinal tumors of unknown origin improves patient
neurological outcome and survival remains unclear. This study aimed to evaluate the
clinical outcomes of emergent decompression/fusion surgery for paralysis caused by spinal
tumors of unknown or not previously diagnosed origin. Patients and Methods: Data from the medical records of 11 patients with
spinal tumors of unknown origin (study group) were compared with those of 15 patients with
metastatic spinal tumors of known origin (control group). The outcome measures were
postoperative performance status, motor function evaluated with the Frankel grade, and
actual survival after surgery as compared with the estimated survival calculated using the
Tokuhashi score. χ2 analyses were performed to evaluate differences between the
groups. Results: The mean performance status was 3.6 preoperatively, which improved
to 2.9 postoperatively (P<0.05), in the unknown origin group and 3.6
preoperatively, which improved to 2.7 postoperatively (P<0.05), in the
control group. Seven patients (64%) in the unknown origin group showed improvement in
paralysis by ≥1 Frankel grade. By contrast, only 4 patients (27%) in the control group
showed improvement in paralysis. The unknown origin group tended to show better
improvement (P=0.05). All the patients in the unknown origin group
underwent adjuvant therapy after definitive diagnosis following surgery. The unknown
origin group showed a slight tendency toward better survival than toward the estimated
survival. Conclusion: Emergent decompression/fusion surgery for patients with
paralysis caused by metastatic tumors of unknown origin is potentially useful for
diagnosing tumor origin and improving neurological outcomes and performance status, and
thus for extending survival.
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Affiliation(s)
- Kousei Miura
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Masao Koda
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Tetsuya Abe
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Mamoru Kono
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Fumihiko Eto
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Hiroshi Kumagai
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Katsuya Nagashima
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Kengo Fujii
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Hiroshi Noguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Toru Funayama
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
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Is Open Surgery for Metastatic Spinal Cord Compression Secondary to Lung Cancer Really Beneficial? A Systematic Review. World Neurosurg 2020; 144:e253-e263. [PMID: 32827738 DOI: 10.1016/j.wneu.2020.08.098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Spinal cord compression secondary to metastatic epidural lung cancer generally has a worse prognosis when compared with other metastatic tumors. The purpose of this study was to determine the impact of open surgery on the survival time, ambulation status, and associated prognostic variables of these patients over the past 2 decades. METHODS We searched the PubMed, MEDLINE, and CENTRAL databases to identify patients with spinal cord compression secondary to metastatic lung cancer. We assessed the role of the following factors on survival outcome and ambulation recovery: Karnofsky Performance Scale, number of extraspinal bone metastases, number of metastases in the vertebrae, major internal organs involvement, vertebral location of spinal metastases, and neurologic status. RESULTS Our initial search yielded 367 articles, from which 11 studies met the eligibility criteria for a total of 395 patients. Significant correlations with the survival period and the recovery in ambulation were found in the prognostic score for the number of metastases in vertebrae (R = 0.74 and 0.88, respectively), and in the prognostic score for metastases to major internal organs (R = 0.82 and 0.81, respectively). A significant correlation with survival period was found in the numbers of extraspinal bone metastases (R = -0.82). The rates of major complications were comparable with those for open surgery for metastatic tumors of other origin. CONCLUSIONS Fewer vertebral metastases and less major internal organ involvement were associated with longer survival periods and greater ambulation recovery in patients undergoing open surgery for spinal cord compression secondary to metastatic lung cancer.
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Lun DX, Chen NW, Feng JT, Yang XG, Xu ZW, Li F, Hu YC. Visceral Metastasis: A Prognostic Factor of Survival in Patients with Spinal Metastases. Orthop Surg 2020; 12:552-560. [PMID: 32227458 PMCID: PMC7189062 DOI: 10.1111/os.12657] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/11/2020] [Accepted: 02/19/2020] [Indexed: 12/12/2022] Open
Abstract
Objective To characterize the visceral metastasis as a predictive tool for the survival of patients with spinal metastases through an exploratory meta‐analysis. Methods Two investigators independently searched PubMed and Embase databases for eligible studies from 2000–2016. The effect estimates for the hazard ratio (HR) or risk ratio (RR) and 95% confidence interval (CI) were collected and pooled with a random‐ or fixed‐effect model. Results In total, 18 eligible studies were retrieved with 5468 participants from nine countries. The overall pooled effect size for HR and RR was 1.50 and 3.79, respectively, which was proved to be statistically significant. In the subgroup of prostate cancer (PCa) and non‐small cell lung cancer (NSCLC), statistical significance and marginal statistical significance was presented for the pooled HR (HR = 1.76, 95% CI 1.35–2.29) and (RR = 1.56, 95% CI 0.99–2.48), respectively. However, in the subgroup of thyroid cancer, breast cancer, and renal cancer, statistical significance was not achieved (HR = 1.17, 95% CI 0.75–1.83, Z = 0.70, P = 0.486). The results did not show any evidence of publication bias. Conclusions This study demonstrated that visceral metastasis was a significant prognostic factor in patients with spinal metastases as a whole. Interestingly, the onset of visceral metastases differentially impacted the survival in different primary tumors. Therefore, the prognostic value of visceral metastasis might be related to the type of primary tumor.
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Affiliation(s)
- Deng-Xing Lun
- Department of Spine Surgery, Weifang People's Hospital, Weifang, China
| | - Nai-Wang Chen
- Department of Spine Surgery, Weifang People's Hospital, Weifang, China
| | - Jiang-Tao Feng
- Graduate School of Tianjin Medical University, Tianjin, China
| | - Xion-Gang Yang
- Graduate School of Tianjin Medical University, Tianjin, China
| | - Zhao-Wan Xu
- Department of Spine Surgery, Weifang People's Hospital, Weifang, China
| | - Feng Li
- Department of Spine Surgery, Weifang People's Hospital, Weifang, China
| | - Yong-Cheng Hu
- Department of Bone Oncology, Tianjin Hospital, Tianjin, China
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Luo J, Zhou Y, Liu H, Hu J. Factors related to the burden of family caregivers of elderly patients with spinal Tumours in Northwest China. BMC Neurol 2020; 20:69. [PMID: 32111172 PMCID: PMC7047359 DOI: 10.1186/s12883-020-01652-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 02/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background Family caregivers of elderly patients with spinal tumours experience considerable pain and burden during the care process. This study aims to investigate the factors associated with caregiver burden in family caregivers of elderly patients with spinal tumours. Methods A total of 220 elderly patients with spinal tumours (age ≥ 65 years) hospitalized at the spine centre of our hospital from January 2015 to December 2017 and their family caregivers were recruited for this cross-sectional study. All participants completed a sociodemographic questionnaire. Caregiver burden, social support and self-efficacy were assessed by the Chinese version of the Zarit Burden Interview (ZBI), the Social Support Rating Scale (SSRS) and the General Self-Efficacy Scale (GSE), respectively. The factors related to caregiver burden were analysed by multivariate analysis. P < 0.05 was considered statistically significant. Results The 216 elderly patients with spinal tumours were 71.59 ± 8.49 years old, and their caregivers were 70.46 ± 9.13 years old. A total of 170 patients were cared for by their spouses, who accounted for 78.7% of all caregivers. The ZBI score for the family caregivers was 35.5 ± 7.5, and most caregivers (84.5%) reported a moderate or heavy burden. The factors related to caregiver burden included patient paralysis, the primary cancer site, chemotherapy and/or radiation, cognitive dysfunction, functional status, monthly income, pain score, caregivers’ SSRS score, and GSE score. Conclusions Most family caregivers of elderly patients with spinal tumours have a considerable caregiver burden. Interventions based on social support and self-efficacy can help reduce caregiver burden.
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Affiliation(s)
- Jing Luo
- Department of Nursing Administration, Honghui Hospital, Xi'an Jiaotong University College of Medicine, 555# You-yi East Road, Xi'an, 710054, Shaanxi, People's Republic of China
| | - Yongchun Zhou
- Department of Orthopedics, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, People's Republic of China
| | - Haiping Liu
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, People's Republic of China
| | - Jing Hu
- Department of Nursing Administration, Honghui Hospital, Xi'an Jiaotong University College of Medicine, 555# You-yi East Road, Xi'an, 710054, Shaanxi, People's Republic of China.
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Lun DX, Xu LN, Wang F, Yang XG, Yu XC, Zhang GC, Hu YC. Prognostic Differences in Patients with Solitary and Multiple Spinal Metastases. Orthop Surg 2019; 11:443-450. [PMID: 31179610 PMCID: PMC6595110 DOI: 10.1111/os.12470] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 04/28/2019] [Indexed: 12/18/2022] Open
Abstract
Objectives To investigate the association between the number of metastases to the spine and survival in patients with metastatic spinal cord compression (MSCC), as well as the prognosis difference between patients with solitary spinal metastasis (SSM) and multiple spinal metastases (MSM). Methods Three institutional databases were searched to identify all patients who had undergone spinal surgery for metastatic spinal tumors between March 2002 and June 2010. As well as age and gender, preoperative medical conditions were collected from medical records, including primary tumor, preoperative Frankel score, other bone metastases, preoperative Karnofsky performance status (KPS), number of involved vertebrae, pathological fracture metastasis site, serum albumin, sphincter dysfunction and the time of developing motor deficits before surgery. Survival data were obtained from medical records or via telephone follow‐ups. Univariate and multivariate predictors of overall survival for each group were assessed using the Cox proportional hazards model. Results The median postoperative survival time was 6.0 ± 0.6 months (95% confidence interval [CI] 4.8–7.2) in patients with SSM and 7.0 ± 1.0 months (95% CI 5.1–8.9) in patients with MSM (P = 0.238). The difference in survival was not significant between groups. Furthermore, univariate analysis showed that the number of spinal metastases had no significant association with survival (P = 0.075). Primary tumor (P = 0.004) and preoperative KPS (P < 0.001) were independent prognostic factors in the whole cohort; primary tumor (P = 0.020), time of developing motor deficit (P = 0.041) and preoperative KPS (P = 0.038) were independent prognostic factors in patients with SSM; while preoperative KPS (P = 0.001) and serum album level (P < 0.001) were independent prognostic factors in patients with MSM. Conclusion The number of spinal metastases has not proven to be useful in predicting the prognosis for patients with MSCC. Consequently, more aggressive operations should be considered for patients with multiple spinal metastases.
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Affiliation(s)
- Deng-Xing Lun
- Department of Spine Surgery, Weifang People's Hospital, Weifang, China
| | - Li-Na Xu
- Department of Respiratory Medicine, Weifang People's Hospital, Weifang, China
| | - Feng Wang
- Graduate School, Tianjin Medical University, Tianjin, China
| | | | - Xiu-Chun Yu
- Department of Orthopaedic Oncology, Jinan Military General Hospital, Jinan, China
| | - Guo-Chuan Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yong-Cheng Hu
- Department of Bone Oncology, Tianjin Hospital, Tianjin, China
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Lun DX, Wang XD, Ji YD, Hu YC, Yang XG, Yu XC, Zhang GC, Zhuang QS. Relationship Between Visceral Metastases and Survival in Patients with Metastasis-related Spinal Cord Compression. Orthop Surg 2019; 11:414-421. [PMID: 30985091 PMCID: PMC6595099 DOI: 10.1111/os.12465] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/03/2019] [Accepted: 04/03/2019] [Indexed: 12/11/2022] Open
Abstract
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.
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Affiliation(s)
- Deng-Xing Lun
- Department of Spine Surgery, Weifang People's Hospital, Weifang, Shandong, China
| | - Xiao-Dong Wang
- Tianjin Traditional Chinese Medicine University, Tianjin, China
| | - Yu-Dong Ji
- Department of Orthopaedic, Sunshine Union Hospital, Weifang, Shandong, China
| | - Yong-Cheng Hu
- Department of Bone Oncology, Tianjin Hospital, Tianjin, China
| | - Xiong-Gang Yang
- Department of Bone Oncology, Tianjin Hospital, Tianjin, China
| | - Xiu-Chun Yu
- Department of Orthopaedic Oncology, Jinan Military General Hospital, Jinan, China
| | - Guo-Chuan Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang Shi, Hebei Sheng, China
| | - Qing-Shan Zhuang
- Department of Spine Surgery, Weifang People's Hospital, Weifang, Shandong, China
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Yang XG, Lun DX, Hu YC, Liu YH, Wang F, Feng JT, Hua KC, Yang L, Zhang H, Xu MY, Zhang HR. Prognostic effect of factors involved in revised Tokuhashi score system for patients with spinal metastases: a systematic review and Meta-analysis. BMC Cancer 2018; 18:1248. [PMID: 30545326 PMCID: PMC6293585 DOI: 10.1186/s12885-018-5139-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 11/27/2018] [Indexed: 12/14/2022] Open
Abstract
Background Cancer patients’ survival time has obviously improved, with the development of systemic treatment techniques. However, the probability of metastases to the vertebrae has also been increased which makes some adverse effects on patients’ quality of life. The prediction of survival plays a key role in choosing therapeutic modality, and Tokuhashi Score was established as one of the most commonly used predictive systems for spinal metastases. Thus, this study was conducted to identify the prognostic effect of factors involved in revised Tokuhashi Score (RTS). Methods Two investigators independently retrieved relevant literature on platforms of PubMed, Embase and Cochrane Library. We identified eligible studies through title/abstract and full-text perusing. Data was extracted including general information of studies, participants’ characteristics, therapeutic modality, overall survival and prognostic effect of factors. Hazard ratio (HR) for each factor was synthesized if available through fixed- or random-effect models as appropriate. Results A total of 63 eligible studies with 10,411 participants were identified. Overall, cases with thyroid cancer had the highest survival rate, while the ones with non-small cell lung cancer and hepatocellular carcinoma lived for the shorted survival time. Performance status, bone metastasis, number of involved vertebrae, visceral metastasis, primary tumor and neurological status were regarded as significant predictors in 71.4, 40.0, 18.2, 63.4, 73.1 and 44.7% of the involved studies respectively. Thirty-eight articles were included in meta-analysis, and prognostic effects of five factors (apart from primary tumor) were analyzed. Factors were all proved to be significant except comparisons between KPS (Karnofsky Performance Status) 10–40 VS. 50–70 and single VS. multiple spinal metastases. Conclusion All factors of RTS were significant on prognosis predicting and should be considered when choosing therapeutic modality for spinal metastases. What’s more, we believe that more accurate prognosis may be obtained after removal of the cut-offs for KPS 10–40 VS. 50–70 and single VS. multiple involved vertebrae. Electronic supplementary material The online version of this article (10.1186/s12885-018-5139-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xiong-Gang Yang
- Department of Bone Tumor of Tianjin Hospital, Tianjin, 300211, China
| | | | - Yong-Cheng Hu
- Department of Bone Tumor of Tianjin Hospital, Tianjin, 300211, China.
| | | | - Feng Wang
- Tianjin Medical university, Tianjin, 300070, China
| | | | - Kun-Chi Hua
- Tianjin Medical university, Tianjin, 300070, China
| | - Li Yang
- Tianjin Medical university, Tianjin, 300070, China
| | - Hao Zhang
- Tianjin Medical university, Tianjin, 300070, China
| | - Ming-You Xu
- Tianjin Medical university, Tianjin, 300070, China
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Prognostic Factors of Ambulatory Status for Patients with Metastatic Spinal Cord Compression: A Systematic Review and Meta-Analysis. World Neurosurg 2018; 116:e278-e290. [DOI: 10.1016/j.wneu.2018.04.188] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/25/2018] [Accepted: 04/25/2018] [Indexed: 02/06/2023]
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16
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da Silva GT, Bergmann A, Thuler LCS. Impact of Symptomatic Metastatic Spinal Cord Compression on Survival of Patients with Non-Small-Cell Lung Cancer. World Neurosurg 2017; 108:698-704. [DOI: 10.1016/j.wneu.2017.09.079] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 09/11/2017] [Accepted: 09/13/2017] [Indexed: 01/05/2023]
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17
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Wang J, Xu H, Zhou S, Wang D, Zhu L, Hou J, Tang J, Zhao J, Zhong S. Body mass index and mortality in lung cancer patients: a systematic review and meta-analysis. Eur J Clin Nutr 2017; 72:4-17. [PMID: 28513621 DOI: 10.1038/ejcn.2017.70] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 04/04/2017] [Accepted: 04/12/2017] [Indexed: 01/19/2023]
Abstract
Studies examining the relation of body mass index (BMI) and mortality in patients with lung cancer have shown diverse results. We conducted a meta-analysis to investigate the association using all available studies from January 1982 to October 2016. PubMed and EMBASE were searched to identify relevant studies. We calculated the summary hazard ratio (HR) and 95% confidence interval (CI) using random effects model. The dose-response relationship was assessed by random effects meta-regression model. Fifty-five articles from 51 studies involving 3 152 552 subjects (males, 54.8%) were included. The pooled results suggested that on average a high BMI decreased risk of death from lung cancer or all-cause. Each 5 kg/m2 increase in BMI had a 12% lower risk of lung cancer-specific mortality (HR=0.88, 95% CI: 0.75-1.02, P=0.09) and a 14% lower risk of all-cause mortality (HR=0.86, 95% CI: 0.77-0.96, P<0.01). When stratifying by ethnicity, each 5 kg/m2 increase in BMI was associated with 22% and 28% reduction, respectively, in the risk of lung cancer-specific mortality (P<0.01) and all-cause mortality (P<0.01) in Asians, but no association was found in Westerners (P=0.51 and P=0.53, respectively). In conclusion, lung cancer patients with a higher BMI have a longer survival than those with a lower BMI. Considering the significant heterogeneity between included studies, future studies are needed to confirm these findings.
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Affiliation(s)
- J Wang
- Department of General Surgery, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, China.,Department of General Surgery, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China
| | - H Xu
- Department of Radiation Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China
| | - S Zhou
- The First Clinical Medical College, Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - D Wang
- Department of General Surgery, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, China
| | - L Zhu
- Department of General Surgery, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, China
| | - J Hou
- Department of General Surgery, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, China
| | - J Tang
- Department of General Surgery, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, China
| | - J Zhao
- Center of Clinical Laboratory Science, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China.,Center of Clinical Laboratory Science, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, China
| | - S Zhong
- Center of Clinical Laboratory Science, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China.,Center of Clinical Laboratory Science, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, China
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Nater A, Martin AR, Sahgal A, Choi D, Fehlings MG. Symptomatic spinal metastasis: A systematic literature review of the preoperative prognostic factors for survival, neurological, functional and quality of life in surgically treated patients and methodological recommendations for prognostic studies. PLoS One 2017; 12:e0171507. [PMID: 28225772 PMCID: PMC5321441 DOI: 10.1371/journal.pone.0171507] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 01/03/2017] [Indexed: 12/13/2022] Open
Abstract
Purpose While several clinical prediction rules (CPRs) of survival exist for patients with symptomatic spinal metastasis (SSM), these have variable prognostic ability and there is no recognized CPR for health related quality of life (HRQoL). We undertook a critical appraisal of the literature to identify key preoperative prognostic factors of clinical outcomes in patients with SSM who were treated surgically. The results of this study could be used to modify existing or develop new CPRs. Methods Seven electronic databases were searched (1990–2015), without language restriction, to identify studies that performed multivariate analysis of preoperative predictors of survival, neurological, functional and HRQoL outcomes in surgical patients with SSM. Individual studies were assessed for class of evidence. The strength of the overall body of evidence was evaluated using GRADE for each predictor. Results Among 4,818 unique citations, 17 were included; all were in English, rated Class III and focused on survival, revealing a total of 46 predictors. The strength of the overall body of evidence was very low for 39 and low for 7 predictors. Due to considerable heterogeneity in patient samples and prognostic factors investigated as well as several methodological issues, our results had a moderately high risk of bias and were difficult to interpret. Conclusions The quality of evidence for predictors of survival was, at best, low. We failed to identify studies that evaluated preoperative prognostic factors for neurological, functional, or HRQoL outcomes in surgical patients with SSM. We formulated methodological recommendations for prognostic studies to promote acquiring high-quality evidence to better estimate predictor effect sizes to improve patient education, surgical decision-making and development of CPRs.
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Affiliation(s)
- Anick Nater
- Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Allan R. Martin
- Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Canada
| | - David Choi
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, and Institute of Neurology, University College London, London, United Kingdom
| | - Michael G. Fehlings
- Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
- Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- * E-mail:
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Kobayashi T, Miyakoshi N, Abe T, Abe E, Kikuchi K, Shimada Y, Matsumoto S, Fukui S. Surgical intervention for vertebral metastases may benefit lung cancer patients no less than other patients: a retrospective study. J Med Case Rep 2017; 11:4. [PMID: 28049505 PMCID: PMC5209804 DOI: 10.1186/s13256-016-1157-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/23/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Spinal metastasis is considered to have a worse prognosis in lung cancer than in other cancers, but recent clinical studies report improved overall survival of lung cancer. We compared the postoperative prognoses of vertebral metastatic tumors from lung with other types of cancer. METHODS From 2011 to 2015, 31 Japanese patients (mean age 73 years, range 55-88 years; 19 males, 12 females) underwent surgery for spinal metastasis at our center. We observed patients retrospectively in March 2016, dividing them into groups by cancer type: lung (LK group, n = 10); prostate, breast, or thyroid (PB group, n = 12); and other (OT group, n = 9). We compared survival and revised Tokuhashi score, which provides a basis for choosing a treatment course. Neurologic status was graded before and after surgery using the Frankel system. RESULTS Mean follow-up was 16.5 months (range 1-62 months). Only seven of 31 patients (22.6%) were alive at final follow-up. Frankel grade significantly improved postoperatively only in the LK (P = 0.01) and PB (P = 0.048) groups. Revised Tokuhashi score differed across groups (P < 0.0001), and was significantly lower in the LK group than in the PB group (P = 0.00) and OT group (P = 0.02). Postoperative survival was significantly shorter in the LK group than in the PB group (P = 0.01) but did not differ between the LK and OT groups. CONCLUSIONS The revised Tokuhashi score may underestimate the survival of lung cancer patients, who may derive the same benefit from surgical intervention as those with vertebral metastasis from other cancer types.
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Affiliation(s)
- Takashi Kobayashi
- Department of Orthopedic Surgery, Akita Kousei Medical Center, 1-1-1 Iijima, Nishifukuro, Akita 011-0948 Japan
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543 Japan
| | - Toshiki Abe
- Department of Orthopedic Surgery, Akita Kousei Medical Center, 1-1-1 Iijima, Nishifukuro, Akita 011-0948 Japan
| | - Eiji Abe
- Department of Orthopedic Surgery, Akita Kousei Medical Center, 1-1-1 Iijima, Nishifukuro, Akita 011-0948 Japan
| | - Kazuma Kikuchi
- Department of Orthopedic Surgery, Akita Kousei Medical Center, 1-1-1 Iijima, Nishifukuro, Akita 011-0948 Japan
| | - Yoichi Shimada
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543 Japan
| | - Seiko Matsumoto
- Department of Anesthesiology, Akita Kousei Medical Center, 1-1-1 Iijima, Nishifukuro, Akita 011-0948 Japan
| | - Shin Fukui
- Department of Respiratory Medicine, Akita Kousei Medical Center, 1-1-1 Iijima, Nishifukuro, Akita 011-0948 Japan
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