Introduction: Symptomatic Metastatic Epidural Spinal Cord Compression (MESCC) afflicts up to 10% of all cancer patients. MESCC is associated with shortened survival and worsened quality of life; thus, early diagnosis and management is crucial. In a multidisciplinary setting, life expectancy must be considered along with other factors, such as overall medical condition, to select the optimal patient-specific treatment plan. This study aims to identify and compare key survival prognostic factors in surgically treated symptomatic MESCC patients.
Methods: Over a five-year period, 145 patients, with a life expectancy greater than 3 months, surgically treated for a single symptomatic MESCC lesion were enrolled in a prospective North American multi-center study. Univariate analyses, Kaplan-Meier methods and log-rank tests, were used to evaluate the prognostic value of various clinical predictors. Non-collinear survival predictors with p < 0.2 in univariate analyses were included into the final Cox proportional hazards model.
Results: The overall median survival was 7.7 months. Lung and breast cancer had the shortest and longest median survival, respectively (4.5 vs. 12.1 months). The type of primary tumor, number of vertebrae involved, ODI, EQ-5D, ASIA score, metastases outside the spine, bladder dysfunction, and ability to walk 4 steps were significant predictors on the univariate analyses. However, the multivariate Cox-regression analysis demonstrated that only spinal metastasis involving four or more vertebral bodies had a negative impact on survival (p = 0.002, HR: 25).
Conclusions: The extent of spinal metastasis, which is regarded as an indicator of the severity of patient’s metastasis burden, is an independent predictor of poor prognosis in patients with a single level symptomatic MESCC lesion. MESCC patients are a challenging and vulnerable heterogenous population. It is essential to identify factors predicting survival, functional, and clinical outcomes in this population to guide patient-centred management to optimize quality of life.
Patient Care: To identify the key survival prognostic factors in patients surgically treated for a single level symptomatic MESCC lesion. To better characterize which MESCC patients are optimally managed by surgical treatment.
Learning Objectives: To identify the key survival prognostic factors in patients surgically treated for a single level symptomatic MESCC lesion. To better characterize which MESCC patients are optimally managed by surgical treatment