Spinal metastases outcome [Neurosurgery Wiki]

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====== Spinal metastases outcome ======

Despite advances in therapies using radiation oncology and spinal oncological surgery, there is a subgroup of patients with [[spinal metastases]] who suffer from progressive or recurrent [[epidural]] disease and remain at risk for neurological compromise.
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The [[prognosis]] with respect to survival essentially depends on the biology of the primary tumor: two-year survival rates for patients with spinal metastases range from 9% (lung cancer) to 44% (breast or prostate cancer)
((Ulmar B, Huch K, Kocak T, Catalkaya S, Naumann U, Gerstner S, Reichel H. Der prognostische Einfluss von Primärtumor und Höhe des befallenen Wirbelsäulenabschnitts bei 217 operativen Patienten mit Wirbelsäulenmetastasen unterschiedlicher Entität [The prognostic influence of primary tumour and region of the affected spinal segment in 217 surgical patients with spinal metastases of different entities]. Z Orthop Ihre Grenzgeb. 2007 Jan-Feb;145(1):31-8. German. doi: 10.1055/s-2007-960506. PMID: 17345541.)).
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[[Preoperative]] status, invasiveness, [[blood loss]]> 500 ml, and [[blood transfusion]]s are independent [[predictor]]s associated with a higher risk of [[complication]]
((Vinas-Rios JM, Rauschmann M, Sellei R, Arabmotlagh M, Sobotke R, Meyer F; DWG-Register study group. Intra-and postoperative complications in the treatment of spinal metastases. A multicentre surveillance study from the German Spinal Registry (DWG-Register). J Neurosurg Sci. 2020 Oct 12. doi: 10.23736/S0390-5616.20.05029-8. Epub ahead of print. PMID: 33047579.)).
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Data from the largest [[prospective]] surgical series of patients with symptomatic [[spinal metastases]] revealed that tumor type, the number of spinal metastases, and the presence of visceral [[metastases]] are the most useful [[predictor]]s of [[survival]] and that [[quality of life]] is best predicted by preoperative [[Karnofsky Performance Score]], Frankel, and EQ-5D scores. The Karnofsky score predicts quality of life and survival and is easy to determine at the bedside, unlike the EQ-5D index. Karnofsky score, tumor type, and spinal and visceral metastases should be considered the 4 most important prognostic variables that influence patient management
((Choi D, Fox Z, Albert T, Arts M, Balabaud L, Bunger C, Buchowski JM, Coppes
MH, Depreitere B, Fehlings MG, Harrop J, Kawahara N, Martin-Benlloch JA,
Massicotte EM, Mazel C, Oner FC, Peul W, Quraishi N, Tokuhashi Y, Tomita K,
Verlaan JJ, Wang M, Crockard HA. Prediction of Quality of Life and Survival After
Surgery for Symptomatic Spinal Metastases: A Multicenter Cohort Study to
Determine Suitability for Surgical Treatment. Neurosurgery. 2015
Nov;77(5):698-708. doi: 10.1227/NEU.0000000000000907. PubMed PMID: 26204361.
)).
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Primary tumor type, presence of visceral metastases and performance status are significant predictors for survival after surgery for symptomatic SEM and should be evaluated before deciding on the extent of treatment. More accurate prediction models are needed to select the best treatment option for the individual patient
((Bollen L, de Ruiter GC, Pondaag W, Arts MP, Fiocco M, Hazen TJ, Peul WC,
Dijkstra PD. Risk factors for survival of 106 surgically treated patients with
symptomatic spinal epidural metastases. Eur Spine J. 2013 Jun;22(6):1408-16. doi:
10.1007/s00586-013-2726-4. Epub 2013 Mar 2. PubMed PMID: 23455954; PubMed Central
PMCID: PMC3676552.)).

===== References =====