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- Title
Outcomes of surgical treatments of spinal metastases: a prospective study.
- Authors
Bouthors, C.; Prost, S.; Court, C.; Blondel, B.; Charles, Y. P.; Fuentes, S.; Mousselard, H. P.; Mazel, C.; Flouzat-Lachaniette, C. H.; Bonnevialle, P.; Saihlan, F.; SOFCOT
- Abstract
<bold>Background: </bold>Owing to recent advances in cancer therapy, updated data are required for clinicians counselling patients on treatment of spinal metastases.<bold>Objective: </bold>To analyse the outcomes of surgical treatments of spinal metastases.<bold>Methods: </bold>Prospective and multicentric study that included consecutively patients operated on for spinal metastases between January 2016 and January 2017. Overall survival was calculated with the Kaplan-Meier method. Cox proportional hazard model was used to calculate hazard ratio (HR) analysing mortality risk according to preoperative Karnofsky performance status (KPS), mobility level and neurological status.<bold>Results: </bold>A total of 252 patients were included (145 males, 107 females) aged a mean 63.3 years. Median survival was 450 days. Primary cancer sites were lung (21%) and breast (19%). Multiple spinal metastases involved 122 patients (48%). Concomitant skeletal and visceral metastases were noted in 90 patients (36%). Main procedure was laminectomy and posterior fixation (57%). Overall, pain and mobility level were improved postoperatively. Most patients had normal preoperative motor function (50%) and remained so postoperatively. Patients "bedbound" on admission were the less likely to recover. In-hospital death rate was 2.4% (three disease progression, one septic shock, one pneumonia, one pulmonary embolism). Complication rate was 33%, deep wound infection was the most frequent aetiology. Higher mortality was observed in patients with poorest preoperative KPS (KPS 0-40%, HR = 3.1, p < 0.001) and mobility level ("bedbound", HR = 2.16, p < 0.001). Survival seemed also to be linked to preoperative neurological function.<bold>Conclusion: </bold>Surgical treatments helped maintain reasonable condition for patients with spinal metastases. Intervention should be offered before patients' condition worsen to ensure better outcomes.
- Subjects
LAMINECTOMY; PROPORTIONAL hazards models; KARNOFSKY Performance Status; METASTASIS; BONE metastasis; LONGITUDINAL method; PAIN management; DISEASE progression; RESEARCH; PAIN; RESEARCH methodology; LUNG tumors; RETROSPECTIVE studies; CANCER relapse; EVALUATION research; MEDICAL cooperation; TREATMENT effectiveness; COMPARATIVE studies; SPINAL tumors; BREAST tumors; SPINE
- Publication
Supportive Care in Cancer, 2020, Vol 28, Issue 5, p2127
- ISSN
0941-4355
- Publication type
journal article
- DOI
10.1007/s00520-019-05015-5