title: Reassessment of scoring systems and prognostic factors for metastatic spinal cord compression.
abstract: BACKGROUND
  The incidence of metastatic spinal cord compression (MSCC) is increasing, paralleling increasing life expectancy of patients. However, management of MSCC and relevance of scoring systems remain controversial.
  
  
  OBJECTIVE
  The aims of our study were to analyze the feasibility and outcomes of spinal surgery, to identify prognostic factors for survival, and to assess the accuracy of scoring systems in patients with malignancies associated with MSCC.
  
  
  METHODS
  Retrospective analysis of all patients with MSCC operated in our institution.
  
  
  METHODS
  Outcomes of surgery, prognostic factors for survival, and relevance of Tomita and Tokuhashi scores were investigated.
  
  
  RESULTS
  One hundred forty-eight patients were included: 66% were hyperalgic (pain score >6) and Frankel score (FS) was decreased in 49%. Seventy-three percent of patients had laminectomy with spinal fixation. After surgery, pain decreased in 75% of cases, FS was improved in 31%, and 92% of patients were ambulatory. Postoperative complication rate was 16%. Median overall survival (OS) was 8.9 months (95% confidence interval, 4.4-13). Only Tokuhashi score was relevant, but predictive accuracy of survival was just 51%. In univariate analyses, hyperalgia (p=.001), primary tumor site, extrabone metastases (p<.001), Karnofsky performance status (KPS) less than 70 (p<.001), poor American Society of Anesthesiologist (ASA) score (p<.001) or FS (p=.01), and absence of postoperative chemotherapy (p<.001) were associated with shorter OS. In multivariate analysis, only extrabone metastases (p=.004), KPS (p=.001), and ASA score (p=.007) remained significantly associated with OS.
  
  
  CONCLUSIONS
  Surgery for MSCC is associated with limited morbidity, improved autonomy, and pain relief. Usual scores do not seem relevant, whereas ASA score, KPS, and extrabone metastases are significantly associated with OS.
authors.affiliation: Department of Medical Oncology, Institut Paoli Calmettes, 232 bd de sainte Marguerite, 13009 Marseille, France.
authors.forename: Emeline
authors.initials: E
authors.lastname: Tabouret
authors.affiliation: Department of Medical Oncology, Institut Paoli Calmettes, 232 bd de sainte Marguerite, 13009 Marseille, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Cauvin
authors.affiliation: Department of Neurosurgery, APHM, Hopital de la Timone, 264 rue Saint Pierre, 13005 Marseille, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Fuentes
authors.affiliation: Department of Biostatistics, Institut Paoli Calmettes, 232 Bd Sainte Marguerite, 13009 Marseille, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Esterni
authors.affiliation: Department of Neurosurgery, APHM, Hopital de la Timone, 264 rue Saint Pierre, 13005 Marseille, France.
authors.forename: Tarek
authors.initials: T
authors.lastname: Adetchessi
authors.affiliation: Department of Radiotherapy, Institut Paoli Calmettes, 232 Bd Sainte Marguerite, 13009 Marseille, France.
authors.forename: Naji
authors.initials: N
authors.lastname: Salem
authors.affiliation: Department of Medical Oncology, Institut Paoli Calmettes, 232 bd de sainte Marguerite, 13009 Marseille, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Madroszyk
authors.affiliation: Department of Medical Oncology, Institut Paoli Calmettes, 232 bd de sainte Marguerite, 13009 Marseille, France.
authors.forename: Anthony
authors.initials: A
authors.lastname: Gonçalves
authors.affiliation: Department of Radiology, Institut Paoli Calmettes, 232 Bd Sainte Marguerite, 13009 Marseille, France.
authors.forename: François
authors.initials: F
authors.lastname: Casalonga
authors.affiliation: Department of Medical Oncology, Institut Paoli Calmettes, 232 bd de sainte Marguerite, 13009 Marseille, France. Electronic address: gravisg@ipc.unicancer.fr.
authors.forename: Gwenaelle
authors.initials: G
authors.lastname: Gravis
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013117:Spinal Cord Compression / Q000473:pathology* / Q000601:surgery; D013125:Spinal Neoplasms / Q000473:pathology* / Q000601:surgery; D016019:Survival Analysis
keywords: Metastatic spinal cord compression; Surgery; Tokuhashi score; Tomita score