Surgery on spinal epidural metastases (SEM) in renal cell carcinoma: a plea for a new paradigm

BACKGROUND CONTEXT: Prediction models for outcome of decompressive surgical resection of spinal epidural metastases (SEM) have in common that they have been developed for all types of SEM, irrespective of the type of primary tumor. It is our experience in clinical practice, however, that these models often fail to accurately predict outcome in the individual patient. PURPOSE: To investigate whether decision making could be optimized by applying tumor-specific prediction models. For the proof of concept, we analyzed patients with SEM from renal cell carcinoma that we have operated on. STUDY DESIGN/SETTING: Retrospective chart analysis 2006 to 2012. PATIENT SAMPLE: Twenty-one consecutive patients with symptomatic SEM of renal cell carcinoma. OUTCOME MEASURES: Predictive factors for survival. METHODS: Next to established predictive factors for survival, we analyzed the predictive value of the Motzer criteria in these patients. The Motzer criteria comprise a specific and validated risk model for survival in patients with renal cell carcinoma. RESULTS: After multivariable analysis, only Motzer intermediate (hazard ratio [HR] 17.4, 95% confidence interval [CI] 1.82-166, p=.01) and high risk (HR 39.3, 95% CI 3.10-499, p=.005) turned out to be significantly associated with survival in patients with renal cell carcinoma that we have operated on. CONCLUSIONS: In this study, we have demonstrated that decision making could have been optimized by implementing the Motzer criteria next to established prediction models. We, therefore, suggest that in future, in patients with SEM from renal cell carcinoma, the Motzer criteria are also taken into account. (C) 2014 Elsevier Inc. All rights reserved.