Predicting survival for surgery of metastatic spinal cord compression in prostate cancer: a new score.
METHODS
We retrospectively analyzed prognostic factors for survival in patients with prostate cancer operated for metastatic spinal cord compression.


OBJECTIVE
The aim was to obtain a clinical score for prediction of survival after surgery.


BACKGROUND
Survival prognosis is important when deciding about treatment of patients with metastatic spinal cord compression. The criteria for identifying patients with prostate cancer who may benefit from surgical treatment are unclear.


METHODS
The study comprised 68 consecutive patients with prostate cancer operated for metastatic spinal cord compression at Umeå University Hospital, Sweden. The indication for surgery was neurological deficit; 53 patients had hormone-refractory prostate cancer and 15 patients had previously untreated, hormone-naïve prostate cancer. In 42 patients, posterior decompression was performed and 26 patients were operated with posterior decompression and stabilization.


RESULTS
A new score for prediction of survival was developed on the basis of the results of survival analyses. The score includes hormone status of prostate cancer, Karnofsky performance status, evidence of visceral metastasis, and preoperative serum prostate-specific antigen (PSA). The total scores ranged from 0 to 6. Three prognostic groups were formulated: group A (n = 32) with scores 0-1; group B (n = 23) with scores 2-4, and group C (n = 12) with scores 5-6. The median overall survival was 3 (0.3-20) months in group A, 16 (1.8-59) months in group B, and more than half (7 of 12) of patients were still alive in group C.


CONCLUSIONS
We present a new prognostic score for predicting survival of patients with prostate cancer after surgery for metastatic spinal cord compression. The score is easy to apply in clinical practice and may be used as additional support when making decision about treatment.
Department of Surgical and Perioperative Sciences (Orthopedics), Umeå University, Umeå, Sweden. sead.crnalic@orthop.umu.se
Sead
S
Crnalic
Richard
R
Löfvenberg
Anders
A
Bergh
Anders
A
Widmark
Christer
C
Hildingsson
D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000401:mortality / Q000601:surgery*; D013125:Spinal Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome