title: Metastatic spinal cord compression in non-small cell lung cancer patients. Prognostic factors in a series of 356 patients.
abstract: BACKGROUND
  Patients with metastatic spinal cord compression (MSCC) from non-small cell lung cancer (NSCLC) have an unfavorable prognosis compared to most other MSCC patients. This study was performed to identify prognostic factors for functional outcome and survival in these patients after radiotherapy (RT) alone.
  
  
  METHODS
  Data of 356 patients irradiated for MSCC from NSCLC were retrospectively analyzed. Ten potential prognostic factors were investigated including age, gender, Eastern cooperative Oncology Group performance score (ECOG-PS), number of involved vertebrae, pre-RT ambulatory status, other bone metastases, visceral metastases, interval from cancer diagnosis to RT of MSCC, time developing motor deficits before RT, and the radiation schedule.
  
  
  RESULTS
  On multivariate analysis, better functional outcome was associated with pre-RT ambulatory status (estimate: - 0.84, p = 0.022), no visceral metastases (estimate: - 1.15, p < 0.001), interval from cancer diagnosis to RT of > 15 months (estimate:  + 0.48, p = 0.019), and slower (> 7 days) development of motor deficits (estimate:  + 1.56, p < 0.001). On multivariate analysis, improved survival was significantly associated with female gender (risk ratio (RR) 1.32, p = 0.043), ECOG-PS 1-2 (RR 1.45, p = 0.034), pre-RT ambulatory status (RR 0.58, p < 0.001), no other bone metastases (RR 1.38, p = 0.010), no visceral metastases (RR 2.87, p < 0.001), interval from cancer diagnosis to RT of > 15 months (RR 0.84, p = 0.035), and slower (> 7 days) development of motor deficits (RR 0.78, p < 0.001).
  
  
  CONCLUSIONS
  This study identified additional independent prognostic factors for outcomes after radiotherapy of MSCC from NSCLC. These prognostic factors can be used for stratification in future trials and can help develop prognostic scores for MSCC from NSCLC.
authors.affiliation: Department of Radiation Oncology, University of Lubeck, Lubeck, Germany. rades.dirk@gmx.net
authors.forename: D
authors.initials: D
authors.lastname: Rades
authors.forename: S
authors.initials: S
authors.lastname: Douglas
authors.forename: T
authors.initials: T
authors.lastname: Veninga
authors.forename: A
authors.initials: A
authors.lastname: Bajrovic
authors.forename: L J A
authors.initials: LJ
authors.lastname: Stalpers
authors.forename: P J
authors.initials: PJ
authors.lastname: Hoskin
authors.forename: V
authors.initials: V
authors.lastname: Rudat
authors.forename: S E
authors.initials: SE
authors.lastname: Schild
mesh_terms: D000367:Age Factors; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009460:Neurologic Examination; D011379:Prognosis; D012189:Retrospective Studies; D012737:Sex Factors; D013116:Spinal Cord / Q000473:pathology; D013117:Spinal Cord Compression / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy*; D013125:Spinal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary*; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden