Introduction.
While the survival rate of various cancer types has improved with the development of multidisciplinary cancer treatment, the number of cases of spinal metastasis from rapid-growth cancer has also increased. This study aimed to compare the surgical outcomes of metastatic spine tumors in primary site differences.
Methods.
214 patients with symptomatic spinal metastases who had undergone spine surgery at our hospital since 2013 were included. Patients were prospectively divided into three groups: The slow-growth group (Slow group), the moderate-growth group (Moderate group), and the Rapid-growth group (Rapid group) based on the new Katagiri classification.The following parameters were assessed: patient background (age, gender, new Katagiri score, SINS, radiation therapy, chemotherapy, number of fusion segments, operation time, estimated blood loss), postoperative clinical scores, and life expectancy.Clinical scores were compared between the three groups regarding ECOGPS, Barthel Index (BI), and EQ5D up to 6 months postoperatively. ECOGPS, BI, and EQ5D were used to evaluate performance status (PS), activity of daily living (ADL), and quality of life (QOL). The Kaplan–Meier method calculated the overall survival rate, and the Cox model compared the three groups. The chi-square test compared the three groups for the subjective health values' improvement, deterioration, and re-deterioration rate.
Results
In total, 214 patients were analyzed (mean age, 67.3 years; range, 24–92 years): Slow group (n=60), Moderate group (n=58), and Rapid group (n=96).Slow group had significantly longer survival than the other two groups. The median survival time was 17.2 months in the Moderate group and 4.5 months in the Rapid group (p<0.001). The median ECOGPS preoperative and postoperative 1, 3, and 6 months were 3,1.5,1,1 for Slow group, 3,2,2,1 for Moderate group, and 3,2,2,1 for Rapid group. BI means were 60.7,83.6,95.1,95.9 for Slow group, 53.7,73.2,87.1,89.7 for Moderate group, and 53.8,66.6,69.3,76.1 for Rapide group. EQ5D mean were 0.148,0.635,0.817,0.82 for Slow group, 0.063,0.523,0.689,0.751 for Moderate group, and 0.010,0.460,0.453,0.525 for Rapid group. The improvement and re-evolution rates of ECOGPS, BI, and EQ5D were not significantly different among the three groups.
Discussion
Although the prognosis of spinal metastasis from rapid-growth cancer is worse than that from slow- and moderate-growth cancer after surgery, PS, ADL, and QOL were improved and maintained during the survival period. We suggest that aggressive surgical intervention should be performed for spinal metastasis from high-grade cancer.