Limits...
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 - Clin Orthop Surg (2015)

Bottom Line: 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.In an analysis according to operation type, there was no significant difference in patient demographics.Preoperative Karnofsky score and improvement of performance status had a significant impact on the survival rate following surgical treatment for these metastatic spine lesions.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

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.

No MeSH data available.


Related in: MedlinePlus

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).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4553283&req=5

Figure 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).

Mentions: When comparing groups according to primary cancer, there was no significant difference in improvement of performance status. Moreover, the mean survival periods, as measured until the last follow-up, were 8.9 and 8.2 months in lung and hepatocellular cancer, respectively, and the difference was found to be statistically insignificant. At 12 months postoperation, cumulative survival rates were 34.7% for lung cancer and 33.7% for hepatocellular cancer (log-rank test, p > 0.05) (Fig. 3). In terms of surgery type, mean survival period until last follow-up was 7.8 and 10.4 months for the P and AP groups, respectively, but the difference was not found to be statistically significant (p = 0.276). Moreover, there was no significant difference in improvement of performance status after operation between the groups (Table 3). At 12 months postoperatively, cumulative survival rates were 31.5% and 38.7% in the P group and AP group, respectively (log-rank test, p > 0.05) (Fig. 4). For the analysis of hazard factors, data for a total of 43 patients were evaluated with Cox regression analysis. The pre- and postoperative pain scale, Tokuhashi score, neurologic status, SINS, and operation type were not statistically shown to affect overall patient survivorship (p > 0.05). However, preoperative Karnofsky performance score and improvement of performance status at 3 months postoperatively were shown to significantly influence survival after surgery. The relative risk of morbidity was found to be 7% lower among subjects with higher preoperative Karnofsky performance scores, holding constant all of the variables in the model and accounting for potential differences in follow-up between the groups (hazard ratio, 0.93; 95% confidence interval [CI], 0.89 to 0.96). The relative risk of morbidity was also found to be 5% lower among subjects with improved performance ratings after surgery (hazard ratio, 0.95; 95% CI, 0.92 to 0.97).


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 - Clin Orthop Surg (2015)

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).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4553283&req=5

Figure 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).
Mentions: When comparing groups according to primary cancer, there was no significant difference in improvement of performance status. Moreover, the mean survival periods, as measured until the last follow-up, were 8.9 and 8.2 months in lung and hepatocellular cancer, respectively, and the difference was found to be statistically insignificant. At 12 months postoperation, cumulative survival rates were 34.7% for lung cancer and 33.7% for hepatocellular cancer (log-rank test, p > 0.05) (Fig. 3). In terms of surgery type, mean survival period until last follow-up was 7.8 and 10.4 months for the P and AP groups, respectively, but the difference was not found to be statistically significant (p = 0.276). Moreover, there was no significant difference in improvement of performance status after operation between the groups (Table 3). At 12 months postoperatively, cumulative survival rates were 31.5% and 38.7% in the P group and AP group, respectively (log-rank test, p > 0.05) (Fig. 4). For the analysis of hazard factors, data for a total of 43 patients were evaluated with Cox regression analysis. The pre- and postoperative pain scale, Tokuhashi score, neurologic status, SINS, and operation type were not statistically shown to affect overall patient survivorship (p > 0.05). However, preoperative Karnofsky performance score and improvement of performance status at 3 months postoperatively were shown to significantly influence survival after surgery. The relative risk of morbidity was found to be 7% lower among subjects with higher preoperative Karnofsky performance scores, holding constant all of the variables in the model and accounting for potential differences in follow-up between the groups (hazard ratio, 0.93; 95% confidence interval [CI], 0.89 to 0.96). The relative risk of morbidity was also found to be 5% lower among subjects with improved performance ratings after surgery (hazard ratio, 0.95; 95% CI, 0.92 to 0.97).

Bottom Line: 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.In an analysis according to operation type, there was no significant difference in patient demographics.Preoperative Karnofsky score and improvement of performance status had a significant impact on the survival rate following surgical treatment for these metastatic spine lesions.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

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.

No MeSH data available.


Related in: MedlinePlus