Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Leitner, L; Bratschitsch, G; Kostwein, A; Sadoghi, P; Smolle, M; Leithner, A; Posch, F.
More help than harm: surgery for metastatic spinal cord compression is associated with more favorable overall survival within a propensity score analysis.
Eur Spine J. 2023; 32(7):2468-2478
Doi: 10.1007/s00586-023-07755-9
Web of Science
PubMed
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- Führende Autor*innen der Med Uni Graz
- Leitner Lukas
- Co-Autor*innen der Med Uni Graz
- Bratschitsch Gerhard
- Leithner Andreas
- Posch Florian
- Sadoghi Patrick
- Smolle Maria Anna
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- Abstract:
- PURPOSE: Indication for surgical decompression in metastatic spinal cord compression (MSCC) is often based on prognostic scores such as the modified Bauer score (mBs), with favorable prognosis suggestive of surgery and poor prognosis of non-surgical management. This study aimed to clarify if (1) surgery may directly affect overall survival (OS) aside from short-term neurologic outcome, (2) explore whether selected patient subgroups with poor mBs might still benefit from surgery, and (3) gauge putative adverse effects of surgery on short-term oncologic outcomes. METHODS: Single-center propensity score analyses with inverse-probability-of-treatment-weights (IPTW) of OS and short-term neurologic outcomes in MSCC patients treated with or without surgery between 2007 and 2020. RESULTS: Among 398 patients with MSCC, 194 (49%) underwent surgery. During a median follow-up of 5.8 years, 355 patients (89%) died. MBs was the most important predictor for spine surgery (p < 0.0001) and the strongest predictor of favorable OS (p < 0.0001). Surgery was associated with improved OS after accounting for selection bias with the IPTW method (p = 0.021) and emerged as the strongest determinant of short-term neurological improvement (p < 0.0001). Exploratory analyses delineated a subgroup of patients with an mBs of 1 point who still benefited from surgery, and surgery did not result in a higher risk of short-term oncologic disease progression. CONCLUSION: This propensity score analysis corroborates the concept that spine surgery for MSCC associates with more favorable neurological and OS outcomes. Selected patients with poor prognosis might also benefit from surgery, suggesting that even those with low mBs may be considered for this intervention.
- Find related publications in this database (using NLM MeSH Indexing)
- Humans - administration & dosage
- Spinal Cord Compression - etiology, surgery
- Propensity Score - administration & dosage
- Retrospective Studies - administration & dosage
- Spinal Neoplasms - surgery, secondary
- Prognosis - administration & dosage
- Find related publications in this database (Keywords)
- Spinal metastasis
- Spinal surgery
- Survival
- Progression
- Neurologic function