title: Prognostic factors in patients with symptomatic spinal metastases and normal neurological function.
abstract: OBJECTIVE
  To evaluate potential prognostic factors for predicting survival after radiotherapy in patients with painful spinal metastases and normal neurological function.
  
  
  METHODS
  In total, 173 patients were included. The following prognostic factors were assessed: primary cancer site, age, gender, albumin and haemoglobin levels, Karnofsky performance status (KPS), analgesic use, pain intensity, number of extraspinal bone metastases and visceral metastases, presence of tumour-conditioned spinal canal stenosis and metastatic spinal cord compression, and extension of spinal metastatic disease on magnetic resonance imaging (MRI). Ongoing systemic treatment, use of bisphosphonates and response to radiotherapy were also evaluated. A simple scoring system for predicting survival was used.
  
  
  RESULTS
  The following predictive factors were found to be significant in multivariate analysis: primary cancer site, KPS, albumin level, number of visceral metastases and analgesic use. Three survival groups were proposed. The overall survival probabilities for groups 1-3 were 13, 46 and 94% at 6 months; 4, 28 and 79% at 12 months, respectively. The median survival times for groups 1-3 were 2.1, 5.5 and 24.9 months, respectively (P < 0.001).
  
  
  CONCLUSIONS
  The pretreatment albumin level was a significant prognostic indicator for survival. Similarly, the primary cancer site, KPS and number of visceral metastases were associated with survival; these findings were consistent with the results of previous studies. The pretreatment analgesic use was significant using the univariate and multivariate analyses and this factor can be verified in future trials. Self-reported pain intensity, pain response to radiotherapy and MRI findings did not influence survival times.
authors.affiliation: Department of Radiology and Nuclear Medicine, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway. Electronic address: m.d.switlyk@medisin.uio.no.
authors.forename: M D
authors.initials: MD
authors.lastname: Switlyk
authors.affiliation: Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Division of Emergency Medicine, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.
authors.forename: U
authors.initials: U
authors.lastname: Kongsgaard
authors.affiliation: Department of Orthopedics, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.
authors.forename: S
authors.initials: S
authors.lastname: Skjeldal
authors.affiliation: Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Radiology and Nuclear Medicine, Rikshospitalet, Oslo University Hospital, Oslo, Norway.
authors.forename: J K
authors.initials: JK
authors.lastname: Hald
authors.affiliation: Department of Radiology and Nuclear Medicine, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors.forename: K H
authors.initials: KH
authors.lastname: Hole
authors.affiliation: Department of Radiology and Nuclear Medicine, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.
authors.forename: K
authors.initials: K
authors.lastname: Knutstad
authors.affiliation: Department of Orthopedics, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.
authors.forename: O
authors.initials: O
authors.lastname: Zaikova
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000532:radiotherapy; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy; D013125:Spinal Neoplasms / Q000503:physiopathology / Q000532:radiotherapy* / Q000556:secondary*; D016019:Survival Analysis
keywords: Magnetic resonance imaging; radiotherapy; spinal metastases; survival