Clin Orthop Surg.  2015 Sep;7(3):344-350. 10.4055/cios.2015.7.3.344.

Factors Affecting Survival in Patients Undergoing Palliative Spine Surgery for Metastatic Lung and Hepatocellular Cancer: Dose the Type of Surgery Influence the Surgical Results for Metastatic Spine Disease?

• Ha KY
• Kim YH
• Ahn JH
• Park HY

• KMID: 2234089
• DOI: http://doi.org/10.4055/cios.2015.7.3.344

Abstract

BACKGROUND
Surgical treatment for metastatic spine disease has been becoming more prominent with the help of technological advances and a few favorable reports on the surgery. In cases of this peculiar condition, it is necessary to establish the role of surgery and analyze the factors affecting survival.
METHODS
From January 2011 to April 2015, 119 patients were surgically treated for metastatic spine lesions. To reduce the bias along the heterogeneous cancers, the primary cancer was confined to either the lung (n = 25) or the liver (n = 18). Forty-three patients (male, 32; female, 11; mean age, 57.5 years) who had undergone palliative surgery were enrolled in this study. Posterior decompression and fusion was performed in 30 patients (P group), and anteroposterior (AP) reconstruction was performed in 13 patients (AP group) for palliative surgery. Pre- and postoperative (3 months) pain (visual analogue scale, VAS), performance status (Karnofsky performance score), neurologic status (American Spinal Injury Association [ASIA] grade), and spinal instability neoplastic score (SINS) were compared. The survival period and related hazard factors were also assessed by Kaplan-Meier and Cox regression analysis.
RESULTS
Most patients experienced improvements in pain and performance status (12.3% +/- 17.2%) at 3 months postoperatively. In terms of neurologic recovery, 9 patients (20.9%) graded ASIA D experienced neurological improvement to ASIA E while the remainder was status quo. In an analysis according to operation type, there was no significant difference in patient demographics. At 12 months postoperatively, cumulative survival rates were 31.5% and 38.7% for the P group and the AP group, respectively (p > 0.05). Survival was not affected by the pre- and postoperative pain scale, Tokuhashi score, neurologic status, SINS, or operation type. Preoperative Karnofsky performance score (hazard ratio, 0.93; 95% confidence interval [CI], 0.89 to 0.96) and improvement of performance status after surgery (hazard ratio, 0.95; 95% CI, 0.92 to 0.97) significantly affected survival after operation.
CONCLUSIONS
There was no significant difference in surgical outcomes and survival rates between posterior and AP surgery for metastatic lesions resulting from lung and hepatocellular cancer. Preoperative Karnofsky score and improvement of performance status had a significant impact on the survival rate following surgical treatment for these metastatic spine lesions.

Keyword

Neoplasm metastasis; Spine; Prognosis

MeSH Terms

Aged
Back Pain
*Decompression, Surgical/adverse effects/methods/mortality
Female
Humans
Kaplan-Meier Estimate
Liver Neoplasms/*pathology
Lung Neoplasms/*pathology
Male
Middle Aged
Pain, Intractable
Palliative Care/*methods
Prognosis
Retrospective Studies
*Spinal Fusion/adverse effects/methods/mortality
*Spinal Neoplasms/mortality/surgery
Spine/*surgery

Figure

• 

  Fig. 1 A 45-year-old man was diagnosed with non-small cell lung cancer. He presented with intractable back pain and progressive lower extremity weakness (Karnofsky performance status 30% and Frankel D). (A) Initial evaluation revealed impending spinal cord injury by pathologic fracture at T10 (spinal instability neoplastic score 15). (B) Anteroposterior reconstruction surgery was done. (C) Postoperative radiotherapy was also applied for this local lesion. At 18 months postoperatively, he still lives actively by himself (Karnofsky performance status 90%).

• 

  Fig. 2 A 73-year-old man was diagnosed with non-small cell lung cancer. He presented with intractable back pain and progressive lower extremity weakness (Karnofsky performance status 70% and Frankel E). (A) Initial evaluation revealed impending spinal cord injury at T10 (spinal instability neoplastic score 7). (B) Posterior decompression and fusion was done. (C) Postoperative radiotherapy was also applied for this local lesion. At 9 months postoperatively, he still lives actively by himself (Karnofsky performance status 80%).

• 

  Fig. 3 Kaplan-Meier analysis revealed cumulative survival rates to be 34.7% for lung cancer patients and 33.7% for hepatocellular cancer (HCC) patients at 12 months postoperatively. There was no statistically significant difference (p > 0.05, log-rank test).

• 

  Fig. 4 Kaplan-Meier analysis revealed cumulative survival rates to be 31.5% for patients who underwent posterior surgery and 38.7% for those who underwent anteroposterior (AP) surgery at 12 months postoperatively. There was no statistically significant difference (p > 0.05, log-rank test).

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