C.02 Predictors of survival in a surgical series of Metastatic Spinal Cord Compression and a complete external validation of 8 models in a prospective multi-centre study

Background: We aimed to identify preoperative predictors of survival in Metastatic Epidural Spinal Cord Compression (MESCC) patients surgically treated, examine how these predictors relate to eight prognostic models, and to perform the first full external validation of these models in accordance with the TRIPOD statement. Methods: 142 surgically treated MESCC patients were enrolled in a prospective, multicenter cohort study and followed for 12 months or until death. Cox proportional hazards (PH) regressions were used. Non-collinear predictors with <10% missing data, ≥10 events per stratum and p<0.05 in univariable analysis were tested through a backward stepwise selection. For the original and revised Tokuhashi, Tomita, modified Bauer, van der Linden, Bartels, OSRI, Bartels and Bollen, we examined calibration and discrimination; survival stratified by risk groups with the Kaplan-Meier method and log-rank test. Results: Primary tumor, organ metastasis and SF-36v2 PC were associated with survival in multivariable analysis; corrected discrimination was 0.68. These three predictors were common to most current prognostic models. However, calibration was poor overall while discrimation was possibly helpful. Conclusions: Primary tumor type (breast, prostate and thyroid), absence of organ metastasis, and a lower degree of physical disability are preoperative predictors of longer survival in surgical MESCC patients. Clinicians should use these 8 prognostic models with caution.

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Metastasizing Meningioma

Neurosurgery ◽

10.1227/00006123-198612000-00022 ◽

1986 ◽

Vol 19 (6) ◽

pp. 1028-1030 ◽

Cited By ~ 27

Author(s):

Tom Russell ◽

T. Moss

Keyword(s):

Computed Tomography ◽

Spinal Cord ◽

Spinal Cord Compression ◽

Primary Tumor ◽

Unusual Case ◽

Clinical Presentation ◽

Spinal Tumor ◽

Cord Compression ◽

Metastatic Spread ◽

Intracranial Meningioma

Abstract A very unusual case of metastatic spread of a meningioma is described. The clinical presentation was of extradural spinal cord compression, without evidence of a primary tumor. Computed tomography did not reveal any intracranial meningioma; the histopathology of the extradural spinal tumor was identical with that of two intracranial meningiomas previously excised.

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Comparison of 5 × 5 Gy and 10 × 3 Gy for metastatic spinal cord compression using data from three prospective trials

Radiation Oncology ◽

10.1186/s13014-020-01737-7 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Dirk Rades ◽

Jon Cacicedo ◽

Antonio J. Conde-Moreno ◽

Barbara Segedin ◽

Darejan Lomidze ◽

...

Keyword(s):

Spinal Cord ◽

Motor Function ◽

Spinal Cord Compression ◽

Treatment Time ◽

Cord Compression ◽

Metastatic Spinal Cord Compression ◽

Motor Deficits ◽

Tumor Type ◽

Ambulatory Status ◽

Local Progression

Abstract Background In a palliative situation like metastatic spinal cord compression (MSCC), overall treatment time of radiotherapy should be as short as possible. This study compared 5 × 5 Gy in 1 week to 10 × 3 Gy in 2 weeks in a prospective cohort. Methods Forty patients receiving 5 × 5 Gy in a phase II trial were matched 1:2 to 213 patients receiving 10 × 3 Gy in two previous prospective studies for tumor type, ambulatory status, time developing motor deficits, interval between tumor diagnosis and MSCC and visceral metastases. These factors were consistent in all three patients (triple) used for each 1:2 matching. Groups were compared for local progression-free survival (LPFS), motor function, ambulatory status, and overall survival (OS). Results After matching, 32 triples remained for analyses (N = 96 in total). Six-month LPFS-rates were 94% after 5 × 5 Gy and 87% after 10 × 3 Gy (p = 0.36), 6-month OS-rates 43% and 35% (p = 0.74). Improvement of motor function was achieved in 59% and 34% of patients (p = 0.028); overall response rates (improvement or no further progression of motor deficits) were 94% and 89% (p = 0.71). Post-treatment ambulatory rates were 81% after 5 × 5 Gy and 85% after 10 × 3 Gy (p = 0.61). Of non-ambulatory patients, 50% (6/12) and 46% (11/24) regained the ability to walk (p = 1.00). Conclusions 5 × 5 Gy in 1 week appeared similarly effective as 10 × 3 Gy in 2 weeks. These results may not be applicable to long-term survivors and should be confirmed in a randomized trial directly comparing 5 × 5 Gy and 10 × 3 Gy. Trial registration clinicaltrials.gov NCT03070431. Registered 27 February 2017.

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31. Development of clinical prognostic models for postoperative survival and quality of life in patients with surgically treated metastatic epidural spinal cord compression

The Spine Journal ◽

10.1016/j.spinee.2019.05.044 ◽

2019 ◽

Vol 19 (9) ◽

pp. S15-S16

Author(s):

Anick Nater ◽

Michael G. Fehlings

Keyword(s):

Quality Of Life ◽

Spinal Cord ◽

Spinal Cord Compression ◽

Cord Compression ◽

Prognostic Models ◽

Postoperative Survival

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Predictive factors of survival in a surgical series of metastatic epidural spinal cord compression and complete external validation of 8 multivariate models of survival in a prospective North American multicenter study

Cancer ◽

10.1002/cncr.31585 ◽

2018 ◽

Vol 124 (17) ◽

pp. 3536-3550 ◽

Cited By ~ 8

Author(s):

Anick Nater ◽

Lindsay A. Tetreault ◽

Branko Kopjar ◽

Paul M. Arnold ◽

Mark B. Dekutoski ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Predictive Factors ◽

Multicenter Study ◽

North American ◽

External Validation ◽

Cord Compression ◽

Multivariate Models

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Analysis of Levels of Metastatic Spinal Cord Compression and Outcome of Surgery in Relation to the Histological Type of Primary Tumor

The Spine Journal ◽

10.1016/j.spinee.2012.08.285 ◽

2012 ◽

Vol 12 (9) ◽

pp. S103 ◽

Cited By ~ 1

Author(s):

Trichy Rajagopal ◽

Nasir A. Quraishi

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Primary Tumor ◽

Cord Compression ◽

Histological Type ◽

Metastatic Spinal Cord Compression ◽

Outcome Of Surgery

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Outcomes for Metastatic Spinal Cord Compression Due to Unknown Primary Tumor: A Five-Year Study from a Single Center

The Spine Journal ◽

10.1016/j.spinee.2017.07.327 ◽

2017 ◽

Vol 17 (10) ◽

pp. S179-S180

Author(s):

Sujay K. Dheerendra ◽

Shreya Srinivas ◽

Radu Popa ◽

Prokopis Annis ◽

Mark McGowan ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Primary Tumor ◽

Cord Compression ◽

Metastatic Spinal Cord Compression ◽

Unknown Primary ◽

Unknown Primary Tumor ◽

Single Center

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NCOG-03. FACTORS ASSOCIATED WITH ADJACENT LEVEL TUMOR PROGRESSION IN PATIENTS RECEIVING SEPARATION SURGERY FOLLOWED BY SPINE STEREOTACTIC RADIOSURGERY FOR METASTATIC EPIDURAL SPINAL CORD COMPRESSION

Neuro-Oncology ◽

10.1093/neuonc/noaa215.542 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii129-ii129

Author(s):

Vikram Chakravarthy ◽

Hammad Khan ◽

Shaarada Srivatsa ◽

Konrad Knusel ◽

Todd Emch ◽

...

Keyword(s):

Spinal Cord ◽

Bone Marrow ◽

Stereotactic Radiosurgery ◽

Spinal Cord Compression ◽

Primary Tumor ◽

Cord Compression ◽

Adjacent Level ◽

Factors Associated ◽

Tumor Histology ◽

Local Bone

Abstract INTRODUCTION Separation surgery followed by spine stereotactic radiosurgery (SSRS) has been shown to achieve favorable rates of local tumor control and patient-reported outcomes in patients with metastatic epidural spinal cord compression (MESCC). If left untreated, MESCC causes severe pain, progressive neurological impairment, and eventual paraplegia with a median survival of 3-6 months. The present study aimed to identify factors associated with adjacent level progression and examine its impact on overall survival (OS) in this population. METHODS This study included 39 patients who received separation surgery followed by SSRS for MESCC. Preoperative, postoperative, and post-SSRS MRIs were used to measure amount of epidural disease, amount of local bone marrow involvement, and adjacent level epidural (AEP) and osseous (AOP) progression. Factors associated with AEP and AOP were examined using the log-rank test and cox proportional hazards modeling. RESULTS Median OS in our cohort was 14.7 mo (2.07-96.3). AEP and AOP were observed in 4/39 (10.3%) and 16/39 (41.0%) patients at a mean of 6.1±5.4 mo and 5.3±5.3 mo post-SSRS, respectively. AEP (7.52 vs. 17.1 mo, p = 0.014) and AOP (13.0 vs. 17.1 mo, p = 0.047) were each significantly associated with decreased OS. Factors associated with AEP included primary tumor histology, low-dose hypofractionated SSRS, increased time from surgery to SSRS, and greater amount of local epidural disease preoperatively (p < 0.05). Factors associated with AOP included greater amount of local bone marrow infiltration by tumor pre- and postoperatively and greater amount of local epidural disease postoperatively (p < 0.05). Primary tumor histology and increased time from surgery to SSRS were associated with AOP by trend (p < 0.10). CONCLUSION This study identifies factors associated with adjacent level progression and shows that AEP and AOP are associated with shorter OS in patients receiving separation surgery followed by SSRS for MESCC.

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Factors associated with adjacent-level tumor progression in patients receiving surgery followed by radiosurgery for metastatic epidural spinal cord compression

Neurosurgical FOCUS ◽

10.3171/2021.2.focus201097 ◽

2021 ◽

Vol 50 (5) ◽

pp. E15

Author(s):

Vikram B. Chakravarthy ◽

Hammad A. Khan ◽

Shaarada Srivatsa ◽

Todd Emch ◽

Samuel T. Chao ◽

...

Keyword(s):

Spinal Cord ◽

Tumor Progression ◽

Spinal Cord Compression ◽

Subgroup Analysis ◽

Cord Compression ◽

Tumor Type ◽

Adjacent Level ◽

Factors Associated ◽

Patient Reported ◽

Index Level

OBJECTIVE Separation surgery followed by spine stereotactic radiosurgery (SSRS) has been shown to achieve favorable rates of local tumor control and patient-reported outcomes in patients with metastatic epidural spinal cord compression (MESCC). However, rates and factors associated with adjacent-level tumor progression (ALTP) in this population have not yet been characterized. The present study aimed to identify factors associated with ALTP and examine its association with overall survival (OS) in patients receiving surgery followed by radiosurgery for MESCC. METHODS Thirty-nine patients who underwent separation surgery followed by SSRS for MESCC were identified using a prospectively collected database and were retrospectively reviewed. Radiological measurements were collected from preoperative, postoperative, and post-SSRS MRI. Statistical analysis was conducted using the Kaplan-Meier product-limit method and Cox proportional hazards test. Subgroup analysis was conducted for patients who experienced ALTP into the epidural space (ALTP-E). RESULTS The authors’ cohort included 39 patients with a median OS of 14.7 months (range 2.07–96.3 months). ALTP was observed in 16 patients (41.0%) at a mean of 6.1 ± 5.4 months postradiosurgery, of whom 4 patients (10.3%) experienced ALTP-E. Patients with ALTP had shorter OS (13.0 vs 17.1 months, p = 0.047) compared with those without ALTP. Factors associated with an increased likelihood of ALTP included the amount of bone marrow infiltrated by tumor at the index level, amount of residual epidural disease following separation surgery, and prior receipt of radiotherapy at the index level (p < 0.05). Subgroup analysis revealed that primary tumor type, amount of preoperative epidural disease, time elapsed between surgery and radiosurgery, and prior receipt of radiotherapy at the index level were significantly associated with ALTP-E (p < 0.05). CONCLUSIONS To the authors’ knowledge, this study is the first to identify possible risk factors for ALTP, and they suggest that it may be associated with shorter OS in patients receiving surgery followed by radiosurgery for MESCC. Future studies with higher power should be conducted to further characterize factors associated with ALTP in this population.

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Development of Clinical Prognostic Models for Postoperative Survival and Quality of Life in Patients With Surgically Treated Metastatic Epidural Spinal Cord Compression

Neurosurgery ◽

10.1093/neuros/nyz310_175 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Anick Nater ◽

Junior Chuang ◽

Kuan Liu ◽

Nasir A Quraishi ◽

Dritan Pasku ◽

...

Keyword(s):

Quality Of Life ◽

Spinal Cord ◽

Spinal Cord Compression ◽

Clinical Decision Making ◽

Cord Compression ◽

Prognostic Models ◽

Physical Component Score ◽

C Statistic ◽

Sf 36

Abstract INTRODUCTION Surgery is generally considered for patients with metastatic epidural spinal cord compression (MESCC) with life expectancy >3 mo. No existing clinical prognostic models (CPMs) of survival are consistently used, and no CPMs exist which predict quality of life (QoL) following surgical treatment. These knowledge gaps are important given the challenges involved in managing MESCC. METHODS Using TRIPOD guidelines and data from 258 patients (AOSpine North America (NA) MESCC study and Nottingham MESCC registry), we created 1-yr survival and QoL CPMs using Cox model and logistic regression with manual backward elimination. The outcome measure for QoL was the minimal clinical important difference (MCID) in EQ5D scores. Internal validation involved 200 bootstrap iterations; calibration and discrimination were evaluated. RESULTS Higher SF-36 physical component score (PCS) (HR: 0.96) was associated with longer survival whereas primary tumor other than breast, thyroid, and prostate (unfavorable, HR: 2.57; others, HR: 1.20), organ metastasis (HR: 1.51), male sex (HR: 1.58), and preoperative radiotherapy (HR: 1.53) were associated with shorter survival (c-statistic: 0.69, 95% CI: 0.64-0.73). KPS < 70% (OR: 2.50), living in NA (OR: 4.06), SF-36 PCS (OR: 0.95) and mental component (OR: 0.96) were associated with the likelihood of achieving a MCID improvement in EQ-5D at 3 mo (c-statistic: 0.74, 95% CI: 0.68-0.79). Calibration for both CPMs was very good. CONCLUSION We developed and internally validated the first CPMs of survival and QoL at 3 mo postoperatively in patients with MESCC using TRIPOD guidelines. A web-based calculator is available (http://spine-met.com) to assist clinical decision-making in this complex patient population.

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