title: Preoperative palsy score has no significant association with survival in non-small-cell lung cancer patients with spinal metastases who undergo spinal surgery.
abstract: BACKGROUND
  Survival is a key factor physicians consider when selecting a treatment modality for the treatment of spinal metastases. Various assessment systems can predict length of survival and facilitate selection of the most appropriate treatment. Spinal palsy is a prognostic parameter in the Tokuhashi scoring system but not in the Tomita scoring system. A limitation of these scoring systems is that studies of them have included different tumor types. The aim of this study was to evaluate the usefulness of preoperative neurological status as a prognostic factor in non-small-cell lung cancer patients with spinal metastases who underwent surgical treatment.
  
  
  METHODS
  From November 2000 to March 2010, 50 patients with symptomatic metastatic spinal cord compression secondary to non-small-cell lung cancer underwent palliative surgery. Data collected included patient age and sex, tumor histology, date of surgery, death or last follow-up, preoperative and postoperative ambulatory status according to the Frankel grading system, body mass index (BMI), number of vertebra involved, number of other bone metastasis, visceral metastasis, and preoperative Karnofsky performance status. Log-rank test and multivariate Cox proportional hazard regressions were used to evaluate possible prognostic factors.
  
  
  RESULTS
  The mean patient age was 61.6 years (range, 20-87 years), and 34 were male and 16 were female. The median postoperative survival time was 7.5 months. The median survival was 2.5 months (95% confidence interval (CI): 1.22-16.3 months) in the Frankel A + B group and 8.0 months (95% CI: 5.52-9.89 months) in the Frankel C + D group (p = 0.87). Multivariate Cox proportional hazard regressions showed that preoperative performance status was significantly associated with survival. Preoperative palsy score had no statistically significant association with survival.
  
  
  CONCLUSIONS
  Preoperative palsy score had no statistically significant association with survival in non-small-cell lung cancer patients with spinal metastases who underwent spinal surgery in this study.
authors.affiliation: Department of Orthopedic Surgery, China Medical University Hospital Taichung, Taiwan, No. 2, Yuh-Der Road, Taichung, 404, Taiwan. yenjenc.tw@yahoo.com.tw.|Department of Orthopedic Surgery, School of Medicine, China Medical University, Taichung, Taiwan. yenjenc.tw@yahoo.com.tw.|Department of Public Health and Department of Health Services Administration, China Medical University, Taiwan, No. 91, Hsueh-Shuh Road, Taichung, 404, Taiwan. yenjenc.tw@yahoo.com.tw.
authors.forename: Yen-Jen
authors.initials: YJ
authors.lastname: Chen
authors.affiliation: Department of Orthopedic Surgery, China Medical University Hospital Taichung, Taiwan, No. 2, Yuh-Der Road, Taichung, 404, Taiwan. bonekid@ms25.hinet.net.
authors.forename: Hsien-Te
authors.initials: HT
authors.lastname: Chen
authors.affiliation: Department of Orthopedic Surgery, China Medical University Hospital Taichung, Taiwan, No. 2, Yuh-Der Road, Taichung, 404, Taiwan. d4749@mail.cmuh.org.tw.|Department of Orthopedic Surgery, School of Medicine, China Medical University, Taichung, Taiwan. d4749@mail.cmuh.org.tw.
authors.forename: Horng-Chaung
authors.initials: HC
authors.lastname: Hsu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010243:Paralysis / Q000175:diagnosis* / Q000401:mortality* / Q000601:surgery; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D015996:Survival Rate / Q000639:trends; D055815:Young Adult