Surgery for spinal metastases may indirectly prolong survival


According to Sanjoon Chen (Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea) and others, surgery for the management of metastatic spinal cord compression (MSCC) could be used as an indirect strategy to prolong survival because the functional improvement seen with surgery may increase a patient’s chance of receiving postoperative adjuvant therapy, which in turn may prolong survival.

Chen et al reported, in The Spine Journal, that the improvement functional outcome observed with surgery for spinal metastases is seen as palliative and that few studies have investigated the relationship between functional outcome and survival. However, they added that recent studies have indicated a tendency towards improved survival in patients with improved functional outcomes following surgery. The authors wrote: “To clarify whether the improved functional outcome could influence the overall patients’ survival, we retrospectively analysed the clinical results of 105 consecutive patients with thoracic MSCC.”

Patients in the study underwent single-stage posterior decompression and stabilisation, with or without corpectomy. The indications for surgery were MSCC with progressive neurologic deficit, spinal instability, incapacitating pain resistant to conservative care, or a combination of these symptoms. Chen et al assessed age, pre- and postoperative Karnofsky Performance Scale (KPS), primary cancer, time from diagnosis to metastasis, metastases to the visceral organs, pre- and postoperative Visual Analogue Scale (VAS) score, pre- and postoperative Frankel grade, and survival after operation.

They found that 71 of the 105 patients in the study received postoperative adjuvant therapy—24 underwent local irradiation for the involved segment only, 20 received systematic chemotherapy, and 27 received systematic chemotherapy only after a radiation dose of 1,200–4,000cGy. Chen et al reported that there was a “propensity that the patients who received the adjuvant therapy had more favourable postoperative functional outcome than the patients who did not undergo the adjuvant therapy.” They explained that 53 of 71 patients who underwent adjuvant therapy had a KPS score of 70 or more compared with 18 of 34 patients who did not undergo adjuvant therapy (p=0.03). Also, 62 patients who received adjuvant therapy maintained ambulatory function compared with 24 patients who did not received adjuvant therapy (p=0.04).

The authors commented: “The postoperative adjuvant therapy was the strongest prognostic factor for survival of patients in multivariate analysis.” Patients who received postoperative adjuvant therapy had a median survival time of nine months while patients who did not received adjuvant therapy had a median survival time of two months (p<0.01). Chen et al stated: “The improved functional status afforded by surgery facilitates more chances to access postoperative adjuvant therapy. Therefore, surgery can indirectly contribute to prolonging the survival of patients with spinal metases.

Concluding, the authors wrote: “The role of surgery in the management of MSCC should be considered not only as an option for symptomatic palliation of the patients but also as a strategy to prolong their survival.”