title: Predictors of survival after surgical treatment of spinal metastasis.
abstract: BACKGROUND
  Surgery for spinal metastasis is a palliative treatment aimed at improving patient quality of life by alleviating pain and reversing or delaying neurologic dysfunction, but with a mean survival time of less than 1 year and significant complication rates, appropriate patient selection is crucial.
  
  
  OBJECTIVE
  To identify the most significant prognostic variables of survival after surgery for spinal metastasis.
  
  
  METHODS
  Chart review was performed on 200 surgically treated spinal metastasis patients at Stanford Hospital between 1999 and 2009. Survival analysis was performed and variables entered into a Cox proportional hazards model to determine their significance.
  
  
  RESULTS
  Median overall survival was 8.0 months, with a 30-day mortality rate of 3.0% and a 30-day complication rate of 34.0%. A Cox proportional hazards model showed radiosensitivity of the tumor (hazard ratio: 2.557, P<.001), preoperative ambulatory status (hazard ratio: 2.355, P=.0001), and Charlson Comorbidity Index (hazard ratio: 2.955, P<.01) to be significant predictors of survival. Breast cancer had the best prognosis (median survival, 27.1 months), whereas gastrointestinal tumors had the worst (median survival, 2.66 months).
  
  
  CONCLUSIONS
  We identified the Charlson Comorbidity Index score as one of the strongest predictors of survival after surgery for spinal metastasis. We confirmed previous findings that radiosensitivity of the tumor and ambulatory status are significant predictors of survival.
authors.affiliation: Stanford University School of Medicine, Department of Neurosurgery, Stanford University Medical Center, Palo Alto, California 94304, USA.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Arrigo
authors.forename: Paul
authors.initials: P
authors.lastname: Kalanithi
authors.forename: Ivan
authors.initials: I
authors.lastname: Cheng
authors.forename: Todd
authors.initials: T
authors.lastname: Alamin
authors.forename: Eugene J
authors.initials: EJ
authors.lastname: Carragee
authors.forename: Stefan A
authors.initials: SA
authors.lastname: Mindea
authors.forename: Jongsoo
authors.initials: J
authors.lastname: Park
authors.forename: Maxwell
authors.initials: M
authors.lastname: Boakye
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000401:mortality*; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D013125:Spinal Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery; D016019:Survival Analysis; D015996:Survival Rate; D055815:Young Adult