Surgery on spinal epidural metastases (SEM) in renal cell carcinoma: a plea for a new paradigm.
BACKGROUND
Prediction models for outcome of decompressive surgical resection of spinal epidural metastases (SEM) have in common that they have been developed for all types of SEM, irrespective of the type of primary tumor. It is our experience in clinical practice, however, that these models often fail to accurately predict outcome in the individual patient.


OBJECTIVE
To investigate whether decision making could be optimized by applying tumor-specific prediction models. For the proof of concept, we analyzed patients with SEM from renal cell carcinoma that we have operated on.


METHODS
Retrospective chart analysis 2006 to 2012.


METHODS
Twenty-one consecutive patients with symptomatic SEM of renal cell carcinoma.


METHODS
Predictive factors for survival.


METHODS
Next to established predictive factors for survival, we analyzed the predictive value of the Motzer criteria in these patients. The Motzer criteria comprise a specific and validated risk model for survival in patients with renal cell carcinoma.


RESULTS
After multivariable analysis, only Motzer intermediate (hazard ratio [HR] 17.4, 95% confidence interval [CI] 1.82-166, p=.01) and high risk (HR 39.3, 95% CI 3.10-499, p=.005) turned out to be significantly associated with survival in patients with renal cell carcinoma that we have operated on.


CONCLUSIONS
In this study, we have demonstrated that decision making could have been optimized by implementing the Motzer criteria next to established prediction models. We, therefore, suggest that in future, in patients with SEM from renal cell carcinoma, the Motzer criteria are also taken into account.
Department of Neurosurgery, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands. Electronic address: n.a.bakker@umcg.nl.
Nicolaas A
NA
Bakker
Department of Neurosurgery, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
Maarten H
MH
Coppes
Department of Neurosurgery, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
Rob A
RA
Vergeer
Department of Neurosurgery, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
Jos M A
JM
Kuijlen
Department of Neurosurgery, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
Rob J M
RJ
Groen
D002292:Carcinoma, Renal Cell / Q000150:complications / Q000556:secondary / Q000601:surgery*; D015331:Cohort Studies; D003661:Decision Support Techniques; D019299:Decompression, Surgical / Q000379:methods*; D018572:Disease-Free Survival; D015174:Epidural Neoplasms / Q000150:complications / Q000556:secondary / Q000601:surgery*; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology*; D015999:Multivariate Analysis; D019635:Neurosurgical Procedures; D018579:Patient Selection; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000209:etiology / Q000601:surgery*
Motzer criteria; Prognostic factors; Renal cell carcinoma; SEM; Stabilization; Surgery