scholarly journals A COMPARISON OF THE TOMITA AND TOKUHASHI SCORES IN SPINAL METASTASIS

2020 ◽  
Vol 19 (4) ◽  
pp. 297-301
Author(s):  
PRISCILA BARILE MARCHI CANDIDO ◽  
FERNANDA MARIA PERRIA ◽  
HERTON RODRIGO DA COSTA ◽  
HELTON LUIZ APARECIDO DEFINO
Keyword(s):  
Surgical Treatment ◽  
Patient Survival ◽  
Spinal Metastasis ◽  
Survival Rates ◽  
Weighted Kappa ◽  
Kappa Coefficient ◽  
Level Of Evidence ◽  
Survival Group ◽  
Tokuhashi Score ◽  
Epidural Compression

ABSTRACT Objective To compare Tokuhashi and Tomita scores in patients with epidural spinal metastasis who underwent surgical treatment. Methods A retrospective evaluation of 103 patients with spinal metastasis and epidural compression who underwent surgical treatment. An analysis was performed of agreement between the survival rates observed in the study sample and the survival rate estimated by the Tomita and Tokuhashi scales. Results The overall accuracy was 39.03% for the Tomita scale and 61.75% for the Tokuhashi scale. Fair agreement (0.38 weighted Cohen’s Kappa coefficient) was observed between patient survival and the Tokuhashi score, and slight agreement (0.25 weighted Kappa coefficient) for the Tomita score. The agreement for both scales was higher for patients with less than six months’ survival, with general accuracy of 79.17% for the Tomita and 70.59% for the Tokuhashi scoring system. Conclusion There was fair and slight agreement between the Tokuhashi and Tomita scores with patient survival group. The agreement was higher for patients with less than six months’ survival. Level of evidence III; Comparative retrospective study.

scholarly journals UNKNOWN PRIMARY TUMOR SITES IN SPINAL METASTASIS

2021 ◽  
Vol 20 (1) ◽  
pp. 64-67
Author(s):  
Priscila Barile Marchi Candido ◽  
Rômulo Pedroza Pinheiro ◽  
Fernanda Maris Peria ◽  
Vinicius Nogueira Toledo ◽  
Herton Rodrigo Tavares Costa ◽  
...  
Keyword(s):  
Clinical Features ◽  
Primary Tumor ◽  
Spinal Metastasis ◽  
Survival Rates ◽  
Unknown Primary ◽  
Unknown Primary Tumor ◽  
Treatment Results ◽  
Level Of Evidence ◽  
Primary Tumor Site ◽  
Epidural Compression

ABSTRACT Objective: The goal of the study was to report the prevalence of spinal metastasis with unknown primary tumor, clinical features, treatment results and patient survival. Methods: A retrospective evaluation of 103 patients with spinal metastasis and epidural compression, who underwent surgical treatment between March 2009 and August 2015. The prevalence of metastatic spinal tumor with unknown primary tumor was evaluated, as well clinical features, survival and treatment results. Results: Of 103 patients with spinal metastasis and epidural compression, seven patients (6.8%) with unknown primary tumor site were identified; five (71.4%) male and two (28.6%) female, with ages ranging from 37 to 67 years (50.7 years). The metastasis was located in the thoracic spine in six of the patients (85.7%) and in the cervical spine in one (14.3%). The mean survival time was 44.8 days. Conclusion: Spinal metastasis with unknown primary tumor was found in 6.8% of patients. The prognosis and outcomes were poor, and patients had poor survival rates. Level of evidence III; Experimental study.

COMPLICATIONS OF SURGICAL TREATMENT OF SPINAL METASTASES

2021 ◽  
Vol 20 (4) ◽  
pp. 300-304
Author(s):  
Priscila Barile Marchi Candido ◽  
Fernanda Maris Peria ◽  
Vinicius Nogueira Toledo ◽  
Herton Rodrigo Tavares Costa ◽  
Helton Luiz Aparecido Defino
Keyword(s):  
Retrospective Study ◽  
Surgical Treatment ◽  
Spinal Metastasis ◽  
Spinal Metastases ◽  
Tumor Location ◽  
Karnofsky Performance Scale ◽  
Tumor Type ◽  
Level Of Evidence ◽  
Epidural Compression ◽  
Performance Scale

ABSTRACT Objectives: To evaluate the complications of surgical treatment in a group of patients with spinal metastasis with epidural compression, undergoing surgical treatment. Methods: This is a comparative retrospective study (level of evidence III), which evaluated 96 patients with spinal metastases undergoing surgical treatment. Intra- and postoperative complications were obtained from the patients’ medical records and correlated with the following clinical characteristics: tumor type, tumor location, neurological deficit, age, number of affected vertebrae, Tokuhashi scale, Tomita scale, Karnofsky performance scale, and type of approach. Results: Complications of surgical treatment were observed in 29 (30.20%) patients. Surgical wound infection was the most frequent complication, observed in 15% of patients. Conclusions: Surgical treatment of spinal metastases presents complications in about 30% of patients and their occurrence should be considered in the treatment planning, weighing the risks and benefits for achieving the treatment goals. Level III evidence; Retrospective Study.

scholarly journals Analysis of predictors of mortality after surgical and non-surgical management in proximal humerus fractures

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Alejandro Garcia-Reza ◽  
Diego Matias Dominguez-Prado ◽  
Constantino Iglesias-Nuñez ◽  
Lucia Alvarez-Alvarez ◽  
Beatriz Hernandez-Gonzalez ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Conservative Treatment ◽  
Proximal Humerus ◽  
Cox Regression ◽  
Survival Rates ◽  
Osteoporotic Fractures ◽  
Fundamental Parameter ◽  
Proximal Humerus Fractures ◽  
Level Of Evidence ◽  
Humerus Fractures

Abstract Background Proximal humerus fractures are one of the main osteoporotic fractures. Choosing between conservative or surgical treatment is a controversial topic in the literature, as is the functional impact. The main aim of our study was to analyse whether patient comorbidities should influence the final therapeutic decision for these fractures. Material and methods We collected data from 638 patients with proximal humerus fractures. The main variable collected was exitus. We also collected the following data: age, gender, type of fracture, laterality, type of treatment, production mechanism, comorbidities and the Charlson comorbidity index (CCI) for each patient. The therapeutic indication used the criteria established by the Upper Limb Unit in our centre. We performed chi-square tests, Fischer’s exact tests and Student’s t-tests to compare the variables. We used the Kaplan–Meier method to analyse both the overall and disease-specific survival rates. We employed the Cox regression model to analyse factors associated with mortality. Results Patients with a CCI greater than 5 showed greater mortality (HR  = 3.83; p  < 0.001) than those with a CCI lower than 5. Within the patients who underwent surgery, those with a CCI higher than 5 had an increased mortality rate (HR  = 22.6; p < 0.001) compared with those with a CCI lower than 5. Within the patients who received conservative treatment, those with a CCI over 5 showed greater mortality (HR  = 3.64; p  < 0.001) than those with a CCI under 5. Conclusions Patients with proximal humerus fractures and associated comorbidities (CCI > 5) presented higher mortality than healthier patients. This mortality risk was greater in patients with comorbidities if surgical treatment was indicated rather than conservative treatment. Patient’s comorbidities should be a fundamental parameter when planning the therapeutic strategy. Level of evidence Level 3.

scholarly journals Usefulness of Tokuhashi Score in Survival Prediction of Patients Operated for Vertebral Metastatic Disease

2017 ◽  
Vol 7 (3) ◽  
pp. 260-265 ◽  
Author(s):  
Marcelo Gruenberg ◽  
Maximiliano E. Mereles ◽  
Gastón O. Camino Willhuber ◽  
Marcelo Valacco ◽  
Matias G. Petracchi ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Spinal Metastasis ◽  
Survival Prediction ◽  
Survival Times ◽  
Primary Tumor Site ◽  
Tokuhashi Score ◽  
Group 3 ◽  
Group 2 ◽  
Almost All ◽  
Group 1

Study Design: Retrospective study. Objective: Spinal metastasis can produce pain, deformity, neurological compromise and can decrease life expectancy. Surgical management is usually indicated for pain control, neurological decompression, and to avoid deformity progression. Tokuhashi et al created a scoring system to estimate survival and stratify surgical treatment based on established parameters. Our objective was to evaluate the usefulness of Tokuhashi scoring (TS) system by comparing the predicted and real survival times and analyze the survival time according to the type of tumor. Methods: From 2004 to 2014, 105 patients with vertebral metastasis who underwent surgical treatment were enrolled and retrospectively analyzed. Preoperative TS was performed in all cases. Patients were classified into 3 groups according to TS; group 1 (TS 0-8), group 2 (TS 9-11), and group 3 (TS 12-15). Patients’ average age was 61.5 years, main primary tumor site were as follows: kidney (23%), lung (19%), and breast (18%). Results: The Tokuhashi general concordance was 67.6%. Per group concordance was as follows: group 1 80%, in group 2, only 33% of concordance was observed. In group 3, 100% of concordance was observed. In group 2, the most common primary sites were breast and kidney and the mean survival was 20 and 22.3 months, respectively, both longer than that expected for this group. Conclusions: Tokuhashi concordance was acceptable in our study, particularly in lower and higher scores. The lesser concordance observed in group 2 (33.3%) was observed in almost all tumors. For our practice, TS constitutes an acceptable tool to define survival, particularly in lower and higher scores.

scholarly journals ASSESSMENT OF THE POSTERIOR APPROACH FOR SURGICAL TREATMENT OF SPINAL METASTATIC BREAST CANCER

2020 ◽  
Vol 28 (1) ◽  
pp. 22-25
Author(s):  
Mariana Demétrio de Sousa Pontes ◽  
Breno de Paula Faleiros Pires ◽  
Felipe de Paula Albuquerque ◽  
Carlos Fernando Pereira da Silva Herrero
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Surgical Treatment ◽  
Posterior Approach ◽  
Spinal Metastasis ◽  
Pedicle Screws ◽  
Metastatic Breast ◽  
Posterior Fixation ◽  
Level Of Evidence ◽  
Posterior Portion

ABSTRACT Objective: To assess the clinical and radiological aspects of patients with spinal metastatic breast cancer who underwent surgical treatment by posterior approach. Methods: This is a retrospective and descriptive study. Clinical assessment included the patient’s sex, age, surgical treatment employed and complications. Radiological assessment comprised the study of the morphopathological characteristics of the lesions. Results: Data from 44 patients (93.2% female) submitted to surgical treatment of spinal metastasis were collected. The average age of diagnosis was 56.79 years. Decompression and posterior fixation with pedicle screws were performed in 43.1% of patients, while 36.3% underwent decompression and posterior fixation with pedicle screws associated with corpectomy and replacement with intersomatic device filled with bone cement. In 20.4%, kyphoplasty was the chosen procedure. Eighteen percent of patients had surgical complications, and the thoracic spine was most affected by the tumor. Conclusion: The clinical and radiological presentation of this group of patients is variable. The posterior portion of the vertebrae was more affected than the anterior. Although surgical treatment by posterior approach does not have the objective of curing the underlying disease, it can present favorable results, with higher rate of complication in major surgeries. Level of evidence IV, Therapeutic Studys.

scholarly journals Management of local recurrence after radical nephrectomy: surgical removal with or without systemic treatment is still the gold standard. Results from a multicenter international cohort

2021 ◽  
Vol 53 (11) ◽  
pp. 2273-2280
Author(s):  
Michele Marchioni ◽  
Petros Sountoulides ◽  
Maria Furlan ◽  
Maria Carmen Mir ◽  
Lucia Aretano ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Local Recurrence ◽  
Systemic Therapy ◽  
Radical Nephrectomy ◽  
Systemic Treatment ◽  
Survival Rates ◽  
Surgical Removal ◽  
Cancer Specific Survival ◽  
Time To Recurrence ◽  
Kaplan Meier

Abstract Objective To evaluate the survival outcomes of patients with local recurrence after radical nephrectomy (RN) and to test the effect of surgery, as monotherapy or in combination with systemic treatment, on cancer-specific mortality (CSM). Methods Patients with local recurrence after RN were abstracted from an international dataset. The primary outcome was CSM. Cox’s proportional hazard models tested the main predictors of CSM. Kaplan–Meier method estimates the 3-year survival rates. Results Overall, 96 patients were included. Of these, 44 (45.8%) were metastatic at the time of recurrence. The median time to recurrence after RN was 14.5 months. The 3-year cancer-specific survival rates after local recurrence were 92.3% (± 7.4%) for those who were treated with surgery and systemic therapy, 63.2% (± 13.2%) for those who only underwent surgery, 22.7% (± 0.9%) for those who only received systemic therapy and 20.5% (± 10.4%) for those who received no treatment (p < 0.001). Receiving only medical treatment (HR: 5.40, 95% CI 2.06–14.15, p = 0.001) or no treatment (HR: 5.63, 95% CI 2.21–14.92, p = 0.001) were both independently associated with higher CSM rates, even after multivariable adjustment. Following surgical treatment of local recurrence 8 (16.0%) patients reported complications, and 2/8 were graded as Clavien–Dindo ≥ 3. Conclusions Surgical treatment of local recurrence after RN, when feasible, should be offered to patients. Moreover, its association with a systemic treatment seems to warrantee adjunctive advantages in terms of survival, even in the presence of metastases.

scholarly journals Effect of a randomized controlled trial on the surgical treatment of spinal metastasis, 2000 through 2010: A population-based cohort study

Cancer ◽  
2013 ◽  
Vol 120 (6) ◽  
pp. 901-908 ◽  
Author(s):  
Michael L. Kelly ◽  
Varun R. Kshettry ◽  
Benjamin P. Rosenbaum ◽  
Andreea Seicean ◽  
Robert J. Weil
Keyword(s):  
Randomized Controlled Trial ◽  
Cohort Study ◽  
Surgical Treatment ◽  
Spinal Metastasis ◽  
Controlled Trial ◽  
Population Based ◽  
Randomized Controlled

Lessons Learnt in Health Management: Paediatric Spinal Tumours: A 6-year Retrospective Review from Central India

2021 ◽  
pp. 097206342110504
Author(s):  
Pranati Sharma ◽  
Shrikant V. Rege ◽  
Nilesh Jain
Keyword(s):  
Rare Disease ◽  
Surgical Resection ◽  
Medical Records ◽  
Spinal Metastasis ◽  
Public Awareness ◽  
Survival Rates ◽  
Central India ◽  
Neurological Status ◽  
Histopathological Diagnosis ◽  
Spinal Tumours

Background: From the management perspective, rare medical conditions do not attract enough attention, though their management can often be resource intensive. Increased awareness among health professionals can lead to early diagnosis of cases and prevention of complications leading to improved outcomes. Paediatric spinal tumours are rare disease entities with an annual incidence of approximately 1 per 1 million children. The profile of spinal tumours in the paediatric population is significantly different than that in adults. In this study we retrospectively analyse a heterogenous variety of paediatric spinal tumours which were treated at our institution over the last 6 years, with the goal of contributing to existing knowledge of this relatively rare disease entity. Methods: This retrospective study includes paediatric patients (under 18 years of age) who underwent surgery for primary spinal tumours from 2014 to 2019. The medical records were reviewed retrospectively and the information regarding clinical presentation, tumour location, operative findings, and postoperative status and functional outcome were analysed. The modified McCormick grade was used to assess the neurological status. Patients with spinal metastasis or incomplete medical records were excluded from the study. Results: Of 74 patients with primary spinal tumours operated at our centre between 2014 to 2019, a total of 8 patients (5 males and 3 females) who met the inclusion criteria were identified for the present study. The mean age of the patients included was 12.1±5.3 and the median follow-up period was 24 months. An improvement in the neurological status, as assessed by the modified McCormick grade, was seen in 37.5% of the patients. Three of the patients received adjuvant radiotherapy, post-surgical resection. A unique feature of this series was the wide variety of cases encountered, as each case had a different histopathological diagnosis, despite being limited by its sample size. Conclusion: Primary paediatric spinal cord tumours are rare, and surgical resection remains the treatment of choice. Adjuvant therapy is warranted in cases of high-grade lesions or recurrences. Through this study, we realised that due to its relative rarity and low incidence, a lack of public awareness can often lead to disproportionately increased morbidity and mortality. Prospective multi-centric studies can provide tools to help develop future management strategies for improved survival rates and reduced complications.

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