title: Risk factors for survival of 106 surgically treated patients with symptomatic spinal epidural metastases.
abstract: OBJECTIVE
  Evaluation of risk factors for survival in patients surgically treated for symptomatic spinal epidural metastases (SEM).
  
  
  METHODS
  One hundred and six patients who were surgically treated for symptomatic SEM in a 10-year period in two cooperatively working hospitals were retrospectively studied for nine risk factors: age, gender, site of the primary tumor, location of the symptomatic spinal metastasis, functional and neurologic status, the presence of visceral metastases and the presence of other spinal and extraspinal bone metastases. Analysis was performed using the Kaplan-Meier method, univariate log-rank tests and Cox-regression models.
  
  
  RESULTS
  Overall median survival was 10.7 months (0.2-107.5 months). Overall 30-day complication rate was 33 %. Multivariate Cox-regression analysis showed that fast growing primary tumors (HR 3.1, 95 % CI 1.6-6.2, p = 0.001), the presence of visceral metastases (HR 1.7, 95 % CI 1.0-2.9, p = 0.033) and a low performance status (HR 2.7, 95 % CI 1.1-6.6, p = 0.025) negatively influenced the survival.
  
  
  CONCLUSIONS
  Primary tumor type, presence of visceral metastases and performance status are significant predictors for survival after surgery for symptomatic SEM and should be evaluated before deciding on the extent of treatment. More accurate prediction models are needed to select the best treatment option for the individual patient.
authors: Department of Orthopedic Surgery, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC, Leiden, The Netherlands. l.bollen@lumc.nl
authors: L
authors: L
authors: Bollen
authors: G C W
authors: GC
authors: de Ruiter
authors: W
authors: W
authors: Pondaag
authors: M P
authors: MP
authors: Arts
authors: M
authors: M
authors: Fiocco
authors: T J T
authors: TJ
authors: Hazen
authors: W C
authors: WC
authors: Peul
authors: P D S
authors: PD
authors: Dijkstra
mesh_terms: D015174:Epidural Neoplasms / Q000401:mortality* / Q000556:secondary* / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors