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  • Prognostic Factors for Survival in Surgical Series of Symptomatic Metastatic Epidural Spinal Cord Compression: A Prospective North American Multi-Centre Study in 142 Patients

    Final Number:

    Anick Nater-Goulet MD; Michael G. Fehlings MD, PhD, FRCS(C), FACS; Lindsay Tetreault Bsc; Branko Kopjar MD; Paul M. Arnold MD; Mark B. Dekutoski MD; Joel Finkelstein MD; Charles Fisher MD; John France MD; Ziya L. Gokaslan MD; Laurence D. Rhines MD; Peter Rose; James M. Schuster MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: Symptomatic Metastatic Epidural Spinal Cord Compression (MESCC) afflicts up to 10% of all cancer patients and is associated with shortened survival and worsened quality of life. This study aims to identify the key survival prognostic factors in MESCC patients who were surgically treated for a single symptomatic lesion.

    Methods: 142 MESCC patients were enrolled in a prospective North American multi-center study and followed postoperatively for 12 months. Using univariate analyses, Kaplan-Meier methods, and log-rank tests the prognostic value of various clinical predictors were assessed. Non-collinear predictors with p < 0.05 in univariate analyses were included in the final Cox proportional hazards model.

    Results: The overall median survival was 7.7 months (range: 3 days – 35.6 months); breast cancer had the longest median survival (12.1 months). Ten patients (7%), whose primary cancer were lung (3), kidney (3), sarcoma (2), prostate (1), and breast (1), died within 30-days postoperatively and 88 had died at 12 months (62%). Univariate analyses yielded eight significant predictors for survival: the growth of primary tumor (Tomita Grade 1 vs Grade 2 and 3), BMI, gender, preoperative SF-36 physical component, EQ-5D, and ODI scores as well as the presence of either visceral or extraspinal bony metastasis. The multiple regression analysis revealed that the Tomita grade (Grade 1 vs Grade 2 and 3; HR: 2.81, p=0007), the absence of visceral metastasis (HR: 2.01; p=0.0044), and higher score on SF-36 physical component (HR: 0.945, p<0.0001) were independent predictors for longer survival regardless of the selection method used (backward, forward, or stepwise).

    Conclusions: Slow growing tumor (Tomita Grade 1), absence of visceral metastasis, and lower degree of preoperative physical disability, as reflected by a higher score on the SF-36 physical component questionnaire, are good prognostic factors for survival in selected patients who underwent surgical treatment for a focal symptomatic MESCC lesion.

    Patient Care: To identify the key survival prognostic factors in patients surgically treated for a single level symptomatic MESCC lesion.

    Learning Objectives: Identify the key survival prognostic factors in patients surgically treated for a single level symptomatic MESCC lesion.


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