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Extent of spinal metastasis should drive patient-centered management of MESCC

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PHOENIX — In a North American multicenter study of 145 patients with symptomatic metastatic epidural spinal cord compression treated operatively, researchers found the extent of  patients’ spinal metastasis was a key prognostic factor in survival.

In a presentation here at Spine Summit 2015: CNS/AANS Section on Disorders of the Spine & Peripheral Nerves Annual Meeting, researcher, Anick Nater-Goulet, MD, said all patients with metastatic epidural spinal cord compression (MESCC) included in the study had a minimum of one symptomatic lesion compressing the spinal cord and 12 months of postoperative follow-up.

“We considered the extent of spinal metastasis as being an indicator of severity of the patients’ metastatic burden,” Nater-Goulet said. “According to our results and the literature, we also considered the site of primary tumor as being an important predictor of prognosis.”

The patients studied were included in a database from the prospective AOSpine North America MESCC study, conducted from March 2008 to March 2013. Average patient age at the time of surgery was 59 years, and all patients had the lung, kidney, breast and prostate as primary sites of tumors. Additionally, 60% of the patients had tumors outside of the spine, according to Nater-Goulet.

“Seventy percent had one vertebral body involved, 71% had the ability to walk four steps independently, and 94% had MESCC and really deep pain,” she said.

Based on the Kaplan-Meier curve, mean patient survival was 7 months.

According to Nater-Goulet, the patients were heterogeneous and a challenging group to treat. Therefore, “it is essential to identify preoperative factors predicting survival and clinical outcome so as to guide patient-centered management strategy and to optimize quality of life,” she said.

Nater-Goulet said the sample size used was small and may be a limitation of the study. — by Susan M. Rapp

Reference:

Nater-Goulet A, et al. Paper #109. Presented at: Spine Summit 2015: CNS/AANS Section on Disorders of the Spine & Peripheral Nerves Annual Meeting. March 4-7, 2015; Phoenix.

Disclosure: Nater-Goulet reports no relevant financial disclosures.