title: Survival and clinical outcomes in patients with metastatic epidural spinal cord compression after spinal surgery: a prospective, multicenter, observational cohort study.
abstract: BACKGROUND
  High quality studies have been challenging to undertake in patients with metastatic epidural spinal cord compression. Nonetheless, in the article "Survival and Clinical Outcomes in Surgically Treated Patients With Metastatic Epidural Spinal Cord Compression: Results of the Prospective Multicenter AOSpine Study" recently published in the Journal of Clinical Oncology, our team provided convincing evidence that spinal surgery improves overall quality of life in patients with this potentially devastating complication of cancer. Considering that metastatic spinal lesions treated with surgery have the highest mean cost among all oncological musculo-skeletal issues, it is essential to provide high quality data to optimize the therapeutic approaches and cost-effective use of health care resources.
  
  
  METHODS
  Although the AOSpine Study provided high quality prospective data, it was primarily limited by the lack of non-operative controls and the relatively small sample size. Given the dearth of medical equipoise and the fundamental difference between patients deemed to be adequate surgical candidates and those who are not amenable to operative intervention, conducting a randomized controlled trial in this patient population was not felt to be ethically or medically feasible. Consequently, the optimal option to overcome limitations of both the lack of controls and the relatively small sample size is through collection of large prospective datasets through rigorously developed and maintained registries.
  
  
  CONCLUSIONS
  With the alarming increase in the incidence of cancer in China and China's parallel growing cancer control efforts, China would offer a fantastic platform to set up a national metastatic spinal lesion registry. Such registry would not only enhance metastatic epidural spinal cord compression translational research but also optimize patient care.
authors.affiliation: Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, ON, Canada.
authors.forename: Anick
authors.initials: A
authors.lastname: Nater
authors.affiliation: Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, ON, Canada. Michael.fehlings@uhn.on.ca.|Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St., 4W-449, Toronto, ON, M5T 2S8, Canada. Michael.fehlings@uhn.on.ca.
authors.forename: Michael G
authors.identifier: http://orcid.org/0000-0002-5722-6364
authors.initials: MG
authors.lastname: Fehlings
mesh_terms: D002681:China; D006801:Humans; D019635:Neurosurgical Procedures; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D012042:Registries; D013117:Spinal Cord Compression / Q000209:etiology* / Q000601:surgery*; D013125:Spinal Neoplasms / Q000556:secondary* / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Clinical outcomes; Cohort study; Metastatic epidural spinal cord compression; Prospective study; Surgery