title: Outcome after surgery for metastatic spinal cord compression in 54 patients with prostate cancer.
abstract: OBJECTIVE
  The criteria for selecting patients who may benefit from surgery of spinal cord compression in metastatic prostate cancer are poorly defined. We therefore studied patients operated for metastatic spinal cord compression in order to evaluate outcome of surgery and to find predictors of survival.
  
  
  METHODS
  We reviewed the records of 54 consecutive patients with metastatic prostate cancer who were operated for spinal cord compression at Umeå University Hospital. The indication for surgery was neurological deficit due to spinal cord compression. 41 patients had hormone-refractory cancer and 13 patients had previously untreated, hormone-naïve prostate cancer. 29 patients were operated with posterior decompression only, and in 25 patients posterior decompression and stabilization was performed.
  
  
  RESULTS
  Preoperatively, 6/54 of patients were able to walk. 1 month after surgery, 33 patients were walking, 15 were non-ambulatory, and 6 had died. Mortality rate was 11% at 1 month, 41% at 6 months, and 59% at 1 year. In the hormone-naïve group, 8/13 patients were still alive with a median postoperative follow-up of 26 months. In the hormone-refractory group, median survival was 5 months. Patients with hormone-refractory disease and Karnofsky performance status (KPS) of ≤ 60% had median survival of 2.5 months, whereas those with KPS of 70% and KPS of ≥ 80% had a median survival of 7 months and 18 months, respectively (p < 0.001). Visceral metastases were present in 12/41 patients with hormone-refractory tumor at the time of spinal surgery, and their median survival was 4 months-as compared to 10 months in patients without visceral metastases (p = 0.003). Complications within 30 days of surgery occurred in 19/54 patients.
  
  
  CONCLUSIONS
  Our results indicate that patients with hormone-naive disease, and those with hormone-refractory disease with good performance status and lacking visceral metastases, may be helped by surgery for metastatic spinal cord compression.
authors.affiliation: Departments of Surgical and Perioperative Sciences, Umeå University, Sweden. sead.crnalic@orthop.umu.se
authors.forename: Sead
authors.initials: S
authors.lastname: Crnalic
authors.forename: Christer
authors.initials: C
authors.lastname: Hildingsson
authors.forename: Pernilla
authors.initials: P
authors.lastname: Wikström
authors.forename: Anders
authors.initials: A
authors.lastname: Bergh
authors.forename: Richard
authors.initials: R
authors.lastname: Löfvenberg
authors.forename: Anders
authors.initials: A
authors.lastname: Widmark
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D011237:Predictive Value of Tests; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology*; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000209:etiology* / Q000601:surgery*; D013120:Spinal Cord Neoplasms / Q000150:complications* / Q000556:secondary; D013125:Spinal Neoplasms / Q000150:complications* / Q000556:secondary; D013548:Sweden; D016896:Treatment Outcome; D016138:Walking