Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Kostwein, A.
Survival of Patients with Spinal Metastases
Humanmedizin; [ Diplomarbeit ] Medical University of Graz; 2021. pp. 52
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Bratschitsch Gerhard
- Leitner Lukas
- Altmetrics:
- Abstract:
- Introduction 80% of cancer patients tend to reach a chronic stage of the disease and develop spinal metastases. In 5 to 10% of them neurological deficits evolve due to the nerve structures being compressed. After spinal metastases develop, the two-year survival rate depends on the primary tumor entity and varies between 10 and 20%. No studies providing class I evidence are available, on which the decision regarding either conservative or surgical therapy can be based. However, there are prognostic scores (Tokuhashi Revised, Modified Bauer Score) that help with the choice of treatment. A statistically verified advantage of surgery on mortality and progress of disease has not yet been adequately quantified. Methods A retrospective analysis of 1,762 patients with spinal metastases treated at the Department of Orthopedics and Trauma, Medical University of Graz between 2004 and 2019 was conducted. Subsequently, the patients who were treated conservatively and those that received surgery, either with or without neurological deficits, were compared with regard to survival, neurological symptoms and progress of disease. Results The most common primary tumor entity with spinal metastases in the observed population was lung cancer (23.0%), closely followed by breast cancer (20.6%) and prostate cancer (20.1%). Metastases were most frequently located in the thoracic parts of the spine, namely in 80.4% of patients. The mean age at the time spinal metastases were diagnosed was 65.8 (±12.4) years and mean life expectancy 1.7 (0.0 – 21.7) years. Entities with a poor prognosis were lung and pancreatic cancer, while breast cancer and multiple myeloma had a significantly better outlook (see Kaplan-Meier curve). Symptoms of spinal cord compression were present in 22.9% of patients, while surgery was performed in 12.2% and radiation therapy in 62.4% of cases. In absolute terms, patients with breast and prostate cancer were operated on most commonly, in relative terms those with renal cell carcinoma (28.8%). Surgery was performed relatively seldom on patients with melanoma (3.0%). A significant (p < 0.005) benefit on survival could be found in patients that were treated surgically. Discussion The data collected shows the most common tumor entities in patients with spinal metastases as well as their prognosis. Existing scoring systems enable the prognosis for patients with spinal metastases to be assessed and consequently appropriate therapy to be recommended. Surgical treatment itself does not seem to have a negative impact on mortality. Progress in therapeutic methods and long-term survival of many patients, despite poor prognosis, leave surgeons with ethical problems in deciding what approach to take.