Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Dardic, M.
Preoperative prognostic scoring systems for patients with spinal metastases -
Evaluation in a recent patient collective
[ Diplomarbeit ] Medical University of Graz; 2012. pp. 52
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Berghold Andrea
- Wibmer Christine Linda
- Altmetrics:
- Abstract:
- Objectives: Patients with advanced cancer disease frequently develop metastases in their vertebral column. Through pain, neurological dysfunction and mechanical instability, these metastases can severely decrease patient´s function and quality of life. Correct estimation of the survival time is crucial in order to implicate the right course of palliative treatment. Based on concluded studies at our department, we conducted a sequel evaluation with an updated dataset in order to analyze the parameters and prognostic scoring systems in more recently treated patients. Materials and Methods: This retrospective study included 196 patients with confirmed spinal metastases of diverse cancer origin treated either surgically (35%) or conservatively (65%) between 2005 and 2010. Possible prognostic factors, such as primary tumor, general condition (Karnofsky Performance Scale KPS), visceral metastases, numbers of spinal and extra spinal metastases, pathological fracture, pre- and post-op. neurologic status, spinal surgery and others were evaluated retrospectively. We calculated the survival time from the date of confirmed spinal metastases to the date of death or last follow-up (minimum follow up: 12 months). Statistical analysis comprised Kaplan-Meier curves and univariate and multivariate Cox regressions. A p-value smaller than 5% was considered significant. Results: Median overall survival for all patients was 7 months (minimum 5 days, maximum 70 months). At the time of analysis 178 patients had deceased (91%) and 18 patients were still alive (9%). Using univariate survival analysis primary tumor, visceral metastases, KPS, number of spinal metastases, gender and pathologic fractures showed statistical significance. In stepwise multivariate analysis primary tumor, visceral metastases, KPS and number of spinal metastases showed a significant influence on survival. All evaluated scoring systems (Tokuhashi original and revised, Tomita, van der Linden and Bauer original and modified) showed significant impact in estimating the survival in this dataset. Conclusions: Absence of visceral metastases, high KPS and favorable primary tumors are strong factors for a good prognosis. Our study showed reliability of the analyzed scoring systems in a recent patient collective. Based on these results we recommend the Bauer modified score for its impact and additionally for its simplicity.