title: Factors affecting survival in 43 consecutive patients after surgery for spinal metastases from thyroid carcinoma.
abstract: OBJECTIVE
  Spinal metastases account for the majority of bone metastases from thyroid cancer. The objective of the current study was to analyze a series of consecutive patients undergoing spinal surgery for thyroid cancer metastases in order to identify factors that influence overall survival.
  
  
  METHODS
  The authors retrospectively reviewed the records of all patients who underwent surgery for spinal metastases from thyroid cancer between 1993 and 2010 at the University of Texas MD Anderson Cancer Center.
  
  
  RESULTS
  Forty-three patients met the study criteria. Median overall survival was 15.4 months (95% CI 2.8-27.9 months) based on the Kaplan-Meier method. The median follow-up duration for the 4 patients who were alive at the end of the study was 39.4 months (range 1.7-62.6 months). On the multivariate Cox analysis, progressive systemic disease at spine surgery and postoperative complications were associated with worse overall survival (HR 8.98 [95% CI 3.46-23.30], p < 0.001; and HR 2.86 [95% CI 1.30-6.31], p = 0.009, respectively). Additionally, preoperative neurological deficit was significantly associated with worse overall survival on the multivariate analysis (HR 3.01 [95% CI 1.34-6.79], p = 0.008). Conversely, preoperative embolization was significantly associated with improved overall survival on the multivariate analysis (HR 0.43 [95% CI 0.20-0.94], p = 0.04). Preoperative embolization and longer posterior construct length were significantly associated with fewer and greater complications, respectively, on the univariate analysis (OR 0.24 [95% CI 0.06-0.93] p = 0.04; and OR 1.24 [95% CI 1.02-1.52], p = 0.03), but not the multivariate analysis.
  
  
  CONCLUSIONS
  Progressive systemic disease, postoperative complications, and preoperative neurological deficits were significantly associated with worse overall survival, while preoperative spinal embolization was associated with improved overall survival. These factors should be taken into consideration when considering such patients for surgery. Preoperative embolization and posterior construct length significantly influenced the incidence of postoperative complications only on the univariate analysis.
authors.affiliation: Department of Neurosurgery, Baylor College of Medicine, Houston;
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Sellin
authors.affiliation: Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas;
authors.forename: Dima
authors.initials: D
authors.lastname: Suki
authors.affiliation: Department of Neurosurgery, Baylor College of Medicine, Houston;
authors.forename: Viraat
authors.initials: V
authors.lastname: Harsh
authors.affiliation: Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland; and.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Elder
authors.affiliation: Department of Neurosurgery, Oakland University William Beaumont School of Medicine, Rochester, Michigan.
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Fahim
authors.affiliation: Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas;
authors.forename: Ian E
authors.initials: IE
authors.lastname: McCutcheon
authors.affiliation: Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas;
authors.forename: Ganesh
authors.initials: G
authors.lastname: Rao
authors.affiliation: Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas;
authors.forename: Laurence D
authors.initials: LD
authors.lastname: Rhines
authors.affiliation: Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas;
authors.forename: Claudio E
authors.initials: CE
authors.lastname: Tatsui
mesh_terms: D000328:Adult; D000368:Aged; D018450:Disease Progression; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013125:Spinal Neoplasms / Q000556:secondary* / Q000601:surgery*; D015996:Survival Rate; D013964:Thyroid Neoplasms / Q000473:pathology*; D016896:Treatment Outcome
keywords: EBRT = external beam radiotherapy; KPS = Karnofsky Performance Scale; NPS = numeric pain scale; PMMA = polymethylmethacrylate; SSRS = spinal stereotactic radiosurgery; oncology; postsurgical survival; spinal metastasis; thyroid carcinoma