title: Primary lesion location influences postoperative survival in patients with metastatic colorectal spinal lesions.
abstract: Spinal metastasis from colorectal cancer occurs rarely. However, with increasing incidence of colorectal cancer in the setting of improved therapies, physicians are more likely to encounter such patients. We performed a retrospective review of patients who underwent spine surgery for metastatic colorectal cancer from 2005-2011. Preoperative, operative and postoperative factors; functional outcome as determined by Karnofsky Performance Status (KPS) and modified Rankin scale (mRS); and survival were recorded. Univariate analysis was performed, with patients stratified into two groups based on the position of the primary cancer, either proximal (colon) or distal (rectum) to the rectosigmoid junction. Fourteen patients, with a median age of 52 (interquartile range [IQR] 48-66)years, underwent 21 spine surgeries for metastatic colorectal cancer. Pain was the common presenting symptom (n=11, 79%), followed by motor weakness (n=8, 57%). Twenty-seven postoperative complications occurred in 11 (52%) patients. Baseline KPS and mRS remained stable in four (29%), improved in two (14%), worsened in six (43%), and was unknown in two (14%) at last follow-up. Patients with spinal metastasis from a rectal primary (n=6) had a significantly longer survival compared to those with a colon primary (n=8), with a median survival of 84 (IQR 56-103) versus 26 (IQR 19-44)months after primary diagnosis (p=0.002), 19 (IQR 13-27) versus five (IQR 3-9)months after spine metastasis diagnosis (p=0.010), and six (IQR 4-14) versus three (IQR 2-4)months after surgery (p=0.030). Patients with spinal metastasis arising from rectal primary lesions display longer survival compared to colon lesions. Consideration of these factors is essential to appropriately assess surgical candidacy.
authors.affiliation: Spine Division, Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-109, Baltimore, MD 21287, USA.
authors.forename: C Rory
authors.initials: CR
authors.lastname: Goodwin
authors.affiliation: Spine Division, Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-109, Baltimore, MD 21287, USA.
authors.forename: Eric W
authors.initials: EW
authors.lastname: Sankey
authors.affiliation: Spine Division, Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-109, Baltimore, MD 21287, USA.
authors.forename: Ann
authors.initials: A
authors.lastname: Liu
authors.affiliation: Spine Division, Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-109, Baltimore, MD 21287, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Abu-Bonsrah
authors.affiliation: Spine Division, Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-109, Baltimore, MD 21287, USA.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Elder
authors.affiliation: Spine Division, Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-109, Baltimore, MD 21287, USA.
authors.forename: Jay
authors.initials: J
authors.lastname: Rhee
authors.affiliation: Spine Division, Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-109, Baltimore, MD 21287, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kosztowski
authors.affiliation: Spine Division, Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-109, Baltimore, MD 21287, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Bydon
authors.affiliation: Spine Division, Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-109, Baltimore, MD 21287, USA.
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Witham
authors.affiliation: Spine Division, Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-109, Baltimore, MD 21287, USA.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Wolinsky
authors.affiliation: Spine Division, Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-109, Baltimore, MD 21287, USA.
authors.forename: Ziya L
authors.initials: ZL
authors.lastname: Gokaslan
authors.affiliation: Spine Division, Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-109, Baltimore, MD 21287, USA. Electronic address: dsciubb1@jhmi.edu.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
mesh_terms: D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology*; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D011184:Postoperative Period; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000401:mortality* / Q000556:secondary* / Q000601:surgery
keywords: Colorectal cancer; Prognoses; Rectal carcinoma; Spinal metastasis; Surgical outcomes