Survival and Clinical Outcomes in Surgically Treated Patients With Metastatic Epidural Spinal Cord Compression: Results of the Prospective Multicenter AOSpine Study

被引：170

作者：

Fehlings, Michael G. ^{[1
]}

Nater, Anick ^{[1
]}

Tetreault, Lindsay ^{[1
]}

Kopjar, Branko ^{[5
]}

Arnold, Paul ^{[6
]}

Dekutoski, Mark ^{[7
]}

Finkelstein, Joel ^{[2
]}

Fisher, Charles ^{[3
,4
]}

France, John ^{[8
]}

Gokaslan, Ziya ^{[9
]}

Massicotte, Eric ^{[1
]}

Rhines, Laurence ^{[10
]}

Rose, Peter ^{[11
]}

Sahgal, Arjun ^{[2
]}

Schuster, James ^{[12
]}

Vaccaro, Alexander ^{[13
]}

机构：

[1] Univ Toronto, Toronto, ON, Canada

[2] Sunnybrook Hlth Sci Ctr, Toronto, ON M4N 3M5, Canada

[3] Univ British Columbia, Vancouver, BC V5Z 1M9, Canada

[4] Vancouver Coastal Hlth, Vancouver, BC, Canada

[5] Univ Washington, Seattle, WA 98195 USA

[6] Univ Kansas, Kansas City, KS USA

[7] CORE Inst, Sun City West, AZ USA

[8] W Virginia Univ, Morgantown, WV 26506 USA

[9] Johns Hopkins Univ, Sch Med, Baltimore, MD USA

[10] Univ Texas MD Anderson Canc Ctr, Houston, TX 77030 USA

[11] Mayo Clin, Rochester, MN USA

[12] Univ Penn, Philadelphia, PA 19104 USA

[13] Thomas Jefferson Univ, Philadelphia, PA 19107 USA

来源：

JOURNAL OF CLINICAL ONCOLOGY | 2016年 / 34卷 / 03期

关键词：

QUALITY-OF-LIFE; DECOMPRESSIVE SURGERY; DISEASE; RADIOTHERAPY; RADIOSURGERY; COMPLICATIONS; MANAGEMENT; RESECTION; CANCER;

D O I：

10.1200/JCO.2015.61.9338

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Purpose Although surgery is used increasingly as a strategy to complement treatment with radiation and chemotherapy in patients with metastatic epidural spinal cord compression (MESCC), the impact of surgery on health-related quality of life (HRQoL) is not well established. We aimed to prospectively evaluate survival, neurologic, functional, and HRQoL outcomes in patients with MESCC who underwent surgical management. Patients and Methods One hundred forty-two patients with a single symptomatic MESCC lesion who were treated surgically were enrolled onto a prospective North American multicenter study and were observed at least up to 12 months. Clinical data, including Brief Pain Inventory, ASIA (American Spinal Injury Association) impairment scale, SF-36 Short Form Health Survey, Oswestry Disability Index, and EuroQol 5 dimensions (EQ-5D) scores, were obtained preoperatively, and at 6 weeks and 3, 6, 9, and 12 months postoperatively. Results Median survival time was 7.7 months. The 30-day and 12-month mortality rates were 9% and 62%, respectively. There was improvement at 6 months postoperatively for ambulatory status (McNemar test, P < .001), lower extremity and total motor scores (Wilcoxon signed rank test, P,.001), and at 6 weeks and 3, 6, and 12 months for Oswestry Disability Index, EQ-5D, and pain interference (paired t test, P < .013). Moreover, at 3 months after surgery, the ASIA impairment scale grade was improved (Stuart-Maxwell test P = .004). SF-36 scores improved postoperatively in six of eight scales. The incidence of wound complications was 10% and 2 patients required a second surgery (screw malposition and epidural hematoma). Conclusion Surgical intervention, as an adjunct to radiation and chemotherapy, provides immediate and sustained improvement in pain, neurologic, functional, and HRQoL outcomes, with acceptable risks in patients with a focal symptomatic MESCC lesion who have at least a 3 month survival prognosis. (C) 2015 by American Society of Clinical Oncology

引用

页码：268 / U136

页数：11

共 43 条

[1] Surgical resection of epidural disease improves local control following postoperative spine stereotactic body radiotherapy [J].