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Prognosis in Patients With Symptomatic Metastatic Spinal Cord Compression: Survival in Different Cancer Diagnosis in a Cohort of 2321 Patients

Morgen, Søren Schmidt MD*; Lund-Andersen, Casper MD*; Larsen, Claus Falck MD, DMSci, MPA; Engelholm, Svend Aage MD, DMSci; Dahl, Benny MD, PhD, DMSci*

doi: 10.1097/BRS.0b013e318294835b
Clinical Case Series

Study Design. A retrospective cohort study of 2321 patients consecutively admitted to one center and diagnosed with acute symptoms of metastatic spinal cord compression (MSCC).

Objective. To assess the possible change in 1-year survival for patients with MSCC from year 2005 through 2010 with respect to the primary cancer diagnosis.

Summary of Background Data. An increasing number of patients are offered surgical treatment for MSCC. Among the reasons for this development are high evidence clinical studies, improved surgical techniques, and an increasing number of patients being treated for an oncological condition. Preoperative scoring systems are routinely used in the evaluation of these patients, and the primary oncological diagnosis is an important variable in all these systems. To our knowledge, no studies in a large group of patients have assessed the change in survival in these patients. This is of relevance because such changes in survival could have implications on the scoring systems used in the preoperative evaluation.

Methods. All patients referred to the university hospital, Rigshospitalet, suspected of acute symptoms caused by spinal metastases and diagnosed with MSCC from January 1, 2005, to December 31, 2010, were included in a retrospective cohort, n = 2321. For all patients primary tumor, treatment, and 1-year survival was registered.

Results. The overall 1-year survival did not change significantly from 2005 to 2010, but there was a significant increase in 1-year survival for the subgroups of patients with lung cancer hazard ratio = 0.93 (P= 0.008, 95% CI: 0.83–0.98) and renal cancer hazard ratio = 0.77 (P= 0.004, 95% CI: 0.56–0.92).

Conclusion. Patients with MSCC from pulmonary and renal cancers experienced improved survival in the study period. No improvement was seen for patients with other oncological diagnoses. This corresponds to reports from oncological studies and could affect preoperative scoring systems.

Level of Evidence: 3

Primary oncological diagnosis is the key parameter in the evaluation of patients with metastatic spinal cord compression (MSCC). Therefore, it is relevant to monitor survival in patients with MSCC with respect to primary diagnosis. This study on 2321 patients with MSCC consecutively admitted for surgical evaluation shows improved survival for patients with pulmonary or renal cancers.

*Spine Section, Department of Orthopedic Surgery

Trauma Center, and

Department of Radiation Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.

Address correspondence and reprint requests to Søren Schmidt Morgen, MD, Spine Section, Department of Orthopedic Surgery, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen; E-mail: smorgen@me.com

Acknowledgment date: March 1, 2013. First revision date: March 22, 2013. Acceptance date: March 22, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

The Danish Strategic Research Council (No. 2142-08-0017) grant funds were received to support this work. Benny Dahl is funded by a grant from Medtronic and Globus Medical.

No relevant financial activities outside the submitted work.

© 2013 by Lippincott Williams & Wilkins