title: Prognostic factor analysis in patients with metastatic spine disease depending on surgery and conservative treatment: review of 577 cases.
abstract: BACKGROUND
  To date, skillful medical management and advanced surgical techniques have provided increased quality of life with less postoperative morbidity in patients with spinal metastasis. We assessed the survival of patients with spinal metastasis according to two treatment modalities: surgery and conservative treatment.
  
  
  METHODS
  From 2005 to 2010, a total of 577 patients (200 surgery, 377 conservative treatment) who had spinal metastasis were enrolled. Prognostic factors and survival were assessed by Cox regression and Kaplan-Meier analyses in patients receiving either surgery or conservative treatment.
  
  
  RESULTS
  The mean age was 59.7 (range 21-87) years in the surgery group and 59.9 (range 28-90) years in the conservative treatment group. The major primary cancers were of lung, liver, and colorectal origin in the surgery group and lung, liver, and breast in the conservative group. The mean±SD Tokuhashi score in the surgery group was 8.12±3.09 and in the conservative group was 8.0±2.8 (not significant). The hazard ratio of the primary cancer group ranged from 1.870 to 3.217 compared to that of the most favorable primary cancer group in all patients. Survival was affected significantly by sex, adjuvant therapy, and postoperative survival in the surgery group and by clinical symptom, metastasis to major internal organ, and primary cancer origin in the conservative group.
  
  
  CONCLUSIONS
  With this retrospective review of 577 cases of spinal metastasis, different prognostic factors depending on the treatment modality were discovered. Hence, consideration of these factors depending on the treatment modality could be helpful in treating patients with spinal metastasis.
authors.affiliation: Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Byung Ho
authors.initials: BH
authors.lastname: Lee
authors.forename: Tae-Hwan
authors.initials: TH
authors.lastname: Kim
authors.forename: Hyun-Soo
authors.initials: HS
authors.lastname: Chong
authors.forename: Eun-Soo
authors.initials: ES
authors.lastname: Moon
authors.forename: Jin-Oh
authors.initials: JO
authors.lastname: Park
authors.forename: Hak-Sun
authors.initials: HS
authors.lastname: Kim
authors.forename: Seung-Hyun
authors.initials: SH
authors.lastname: Kim
authors.forename: Hwan-Mo
authors.initials: HM
authors.lastname: Lee
authors.forename: Yong-jin
authors.initials: YJ
authors.lastname: Cho
authors.forename: Keung Nyun
authors.initials: KN
authors.lastname: Kim
authors.forename: Seong-Hwan
authors.initials: SH
authors.lastname: Moon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001416:Back Pain / Q000209:etiology; D001940:Breast / Q000473:pathology*; D015179:Colorectal Neoplasms / Q000473:pathology*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000473:pathology*; D008175:Lung Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000209:etiology; D009362:Neoplasm Metastasis; D016016:Proportional Hazards Models; D011843:Radiculopathy / Q000209:etiology; D012189:Retrospective Studies; D012737:Sex Factors; D013125:Spinal Neoplasms / Q000150:complications / Q000556:secondary* / Q000601:surgery / Q000628:therapy*; D055815:Young Adult