General Session: Tumor, Trauma, Infection - Hall F

Presented by: A. Nater

Author(s):

A. Nater(1), L.A. Tetreault(2), B. Kopjar(3), P.M. Arnold(4), M.B. Dekutoski(5), J.A. Finkelstein(6), C.G. Fisher(7), J.C. France(8), Z.L. Gokaslan(9), L. Rhines((1)0), P.S. Rose((1)(1)), A. Sahgal(6), J.M. Schuster((1)(2)), A.R. Vaccaro((1)(3)), M.G. Fehlngs((1)(4))

(1) University of Toronto, Toronto, ON, Canada
(2) University College Cork, Graduate Entry Medicine, Cork, Ireland
(3) University of Washington, Seattle, WA, United States
(4) University of Kansas Medical Center, Kansas, KS, United States
(5) The CORE Institute, Sun City West, AZ, United States
(6) Sunnybrook Health Sciences Center, Toronto, ON, Canada
(7) University of British Columbia and Vancouver Coastal Health, Vancouver, ON, Canada
(8) West Virginia University, Morgantown, WV, United States
(9) The Warren Alpert Medical School of Brown University, Providence, RI, United States
((1) 0) MD Anderson Cancer Center, Houston, TX, United States
((1) (1) ) Mayo Clinic, Rochester, MN, United States
((1) (2) ) University of Pennsylvania, Philadelphia, PA, United States
((1) (3) ) Thomas Jefferson University, Philadelphia, PA, United States
((1) (4) ) Toronto Western Hospital, University Health Network, Toronto, ON, Canada

Abstract

Introduction: Metastatic Epidural Spinal Cord Compression (MESCC) afflicts up to 10% of cancer patients. Few prospective studies have evaluated key preoperative clinical factors of survival such as scores on patient-assessed questionnaires, patient factors and tumor characteristics, using multivariable analysis in adult patients treated surgically for a single MESCC lesion. These results could help modify or develop new predictive scoring systems.

Methods: One hundred and forty-two surgical MESCC patients were enrolled in a prospective, multicenter, North American, cohort study and followed postoperatively for at least 12 months or until death. Cox proportional hazards regression was used following the assessment of the proportional hazards assumption. Non-collinear, preoperative predictors of survival with < 10% missing data, ≥10 events per stratum and p< 0.05 in univariable analysis were tested through a backward stepwise selection process.

Results: The median survival was about 7.5 months. A total of 88 patients died and 54 were censored. Seven factors were significant in univariable analysis: growth of primary tumor (Tomita tumor grade), sex, lymph node/other organ metastasis, body mass index, and SF-36v2 physical component, EQ-5D and Oswestry disability index (ODI) scores. Since the ODI*time term was significant, it was included in the multivariable model. Tomita tumor Grade II/III (HR: 2.767, 95% CI: 1.520-5.035, p=0.0009), presence of lymph node/other organ metastasis (HR: 2.044, 95% CI: 1.259-3.319, p=0.0038), and SF-36v2 physical component score (HR: 0.945, 95% CI: 0.920-0.970, p< 0.0001) had an independent effect on survival.

Conclusions: Slow growing tumor (Tomita tumor Grade I), absence of lymph node/other organ metastasis, and lower degree of preoperative physical disability, as reflected by a higher score on the SF-36v2 physical component questionnaire, are independent preoperative clinical factors associated with longer survival in patients treated surgically for a focal MESCC lesion.