General Session: Tumor, Trauma, and Infection

Presented by: S-J Park - View Audio/Video Presentation (Members Only)

Author(s):

S.-J. Park(1), C.-S. Lee(1), S.-S. Chung(1), K.-J. Lee(1), C.-D. Park(1)

(1) Samsung Medical Center, Sunghyunkwan University School of Medicine, Orthopedic Surgery, Seoul, Korea, Republic of

Abstract

Background: A number of studies have reported the prognostic factors of spinal metastases. However, there are few studies about spine metastasis as the initial manifestation of malignancy. So, the aim of this study is to evaluate the incidence and prognosis of the patients who underwent the surgical treatment for the spinal metastases as the first manifestation of malignant tumors.

Methods: From January 1994 to December 2014, we reviewed retrospectively 338 patients who underwent surgical treatment for metastatic spinal tumors. Through the patients' electronic medical records, enrolled patients were divided into two groups. Group A means the patients who had no history of malignancy and were diagnosed with primary malignancy site through spinal metastases. Group B means the patients who had the treatment history of primary malignant site and spine metastases developed subsequently. The incidence of group A was evaluated according to the primary malignancy sites. The survival time was calculated using Kaplan-Meier survivorship analysis. The prognostic factors affecting the postoperative survival time were investigated using Cox-hazards regression analysis.

Result: The study cohorts consisted of 209 males and 129 females. The patients' mean age at the surgical treatment was 57.3 years. During the follow-up period, 264 patients were died and 74 patients were alive. Mean postoperative survival time was 11.5 months (range, 0.6-105.4 months). The incidence of group A was 94 out of 338 patients (27.7%). According to primary malignancy site, the incidence of lung cancer was 35/103 patients (34.0%), liver cancer in 8/45 patients (17.8%), kidney cancer in 10/33 patients (30.3%), colorectal cancer in 3/29 patients (10.3%), breast cancer in 3/22 patients (13.6%), prostate cancer in 3/10 patients (30%), thyroid cancer in 4/8 patients (50%) and others carcinoma were in 28/88 patients (31.8%). Kaplan-Meier survival analysis showed that the survival time of group A was significantly longer than that of group B (p = 0.012). Multivariate analysis revealed that the primary site, preoperative ECOG performance status, and group A/B were significant prognostic factors (p=0.009, p< 0.001, and p=0.005, respectively).

Conclusion: Among the enrolled 338 patients who underwent surgical treatment for spine metastases, the incidence of spine metastases as the initial manifestation of primary malignancy was 94 patients (27.7%). The inaugural spine metastasis was shown to be a good prognostic factor affecting the postoperative survival time.