title: Clinical outcome and survival after palliative surgery for spinal metastases: palliative surgery in spinal metastases.
abstract: BACKGROUND
  The authors sought to identify treatment-related factors that influenced survival after surgical treatment for metastatic spinal tumors and to evaluate the relationship between survival and postoperative ambulation time as a factor related to quality of life.
  
  
  METHODS
  The medical records of 81 patients with metastatic spinal tumors who underwent palliative surgery at the study institution were assessed. Univariate analysis for factors influencing survival used the Kaplan-Meier log rank statistic and multivariate analysis used the Cox proportional hazards model. The Spearman correlation test was used to analyze the relationship between postoperative ambulation and survival time.
  
  
  RESULTS
  The patients had a median age of 59.9 years and a median survival of 10.6 months after surgery. For patients, postoperative ambulatory median survival was 16.5 months and median ambulation time was 13.8 months. By univariate analysis, anatomic site of the primary tumor, postoperative ambulation, and combined adjuvant therapy (chemotherapy plus radiotherapy) were associated with prolonged survival (P < 0.05). Multivariate analysis identified primary site and postoperative ambulatory function as independent predictors of prolonged survival (P < 0.0001). Significant correlations were found between ambulation time and survival time of patients who were able to walk after surgery (P < 0.0001), even in patients with liver (P < 0.05) or lung carcinoma (P < 0.05).
  
  
  CONCLUSIONS
  The anatomic site of primary carcinoma and postoperative ambulation were associated with longer survival after palliative surgery for metastatic spinal tumor. When ambulation is attained after surgery, it can be preserved until late in remaining life even when the primary tumor is unfavorable. Palliative surgery for spinal metastasis can improve the quality and quantity of life.
authors.affiliation: Department of Orthopaedic Surgery, Shinshu University School of Medicine, Asahi-Matsumo City, Nagano, Japan. hirokihi@hsp.md.shinshu-u.ac.jp
authors.forename: Hiroki
authors.initials: H
authors.lastname: Hirabayashi
authors.forename: Sohei
authors.initials: S
authors.lastname: Ebara
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Kinoshita
authors.forename: Yohei
authors.initials: Y
authors.lastname: Yuzawa
authors.forename: Isao
authors.initials: I
authors.lastname: Nakamura
authors.forename: Jun
authors.initials: J
authors.lastname: Takahashi
authors.forename: Mikio
authors.initials: M
authors.lastname: Kamimura
authors.forename: Kuniyoshi
authors.initials: K
authors.lastname: Ohtsuka
authors.forename: Kunio
authors.initials: K
authors.lastname: Takaoka
mesh_terms: D004434:Early Ambulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D016016:Proportional Hazards Models; D011788:Quality of Life; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000556:secondary* / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome