Survival Rate and Neurological Outcome after Operation for Advanced Spinal Metastasis (Tomita’s Classification ≥ Type 4)

다국어 초록 (Multilingual Abstract)

Purpose: We investigated whether primary malignancy entities and the extent of tumor resection have an effect on
the survival rate and neurological improvement in patients with spinal metastases that extend beyond the vertebral
compartment (Tomita’s classification ≥ type 4). Materials and Methods: We retrospectively reviewed 87 patients
with advanced spinal metastasis who underwent surgery. They were divided into groups 1 and 2 according to
whether they responded to adjuvant therapy or not, respectively. They were subdivided according to the extent of
tumor resection: group 1, gross total resection (G1GT); group 1, subtotal resection (G1ST); group 2, gross total
resection (G2GT); and group 2, subtotal resection (G2ST). The origin of the tumor, survival rate, extent of
resection, and neurological improvement were analyzed. Results: Group 1 had a better survival rate than group 2.
The G1GT subgroup showed a better prognosis than the G1ST subgroup. In group 2, the extent of tumor resection
(G2GT vs. G2ST) did not affect survival rate. In all subgroups, neurological status improved one month after
surgery, however, the G2ST subgroup had worsened at the last follow-up. There was no local recurrence at the last
follow-up in the G1GT subgroup. Four out of 13 patients in the G2GT subgroup showed a local recurrence of
spinal tumors and progressive worsening of neurological status. Conclusion: In patients with spinal metastases
(Tomita’s classification ≥ type 4), individuals who underwent gross total resection of tumors that responded to
adjuvant therapy showed a higher survival rate than those who underwent subtotal resection. For tumors not
responding to adjuvant therapy, we suggest palliative surgical decompression.

다국어 초록 (Multilingual Abstract)

Purpose: We investigated whether primary malignancy entities and the extent of tumor resection have an effect on
the survival rate and neurological improvement in patients with spinal metastases that extend beyond the vertebral
compartment (Tomita’s classification ≥ type 4). Materials and Methods: We retrospectively reviewed 87 patients
with advanced spinal metastasis who underwent surgery. They were divided into groups 1 and 2 according to
whether they responded to adjuvant therapy or not, respectively. They were subdivided according to the extent of
tumor resection: group 1, gross total resection (G1GT); group 1, subtotal resection (G1ST); group 2, gross total
resection (G2GT); and group 2, subtotal resection (G2ST). The origin of the tumor, survival rate, extent of
resection, and neurological improvement were analyzed. Results: Group 1 had a better survival rate than group 2.
The G1GT subgroup showed a better prognosis than the G1ST subgroup. In group 2, the extent of tumor resection
(G2GT vs. G2ST) did not affect survival rate. In all subgroups, neurological status improved one month after
surgery, however, the G2ST subgroup had worsened at the last follow-up. There was no local recurrence at the last
follow-up in the G1GT subgroup. Four out of 13 patients in the G2GT subgroup showed a local recurrence of
spinal tumors and progressive worsening of neurological status. Conclusion: In patients with spinal metastases
(Tomita’s classification ≥ type 4), individuals who underwent gross total resection of tumors that responded to
adjuvant therapy showed a higher survival rate than those who underwent subtotal resection. For tumors not
responding to adjuvant therapy, we suggest palliative surgical decompression.

참고문헌 (Reference)

1 Tomita K, "Total en bloc spondylectomy for spinal tumors: improvement of the technique and its associated basic background" 11 : 3-12, 2006

2 Frankel HL, "The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia" 7 : 179-192, 1969

3 Böhm P, "The surgical treatment of bony metastases of the spine and limbs" 84 : 521-529, 2002

4 Nather A, "The results of decompression of cord or cauda equina compression from metastatic extradural tumors" 103-108, 1982

5 Tatsui H, "Survival rates of patients with metastatic spinal cancer after scintigraphic detection of abnormal radioactive accumulation" 21 : 2143-2148, 1996

6 Tomita K, "Surgical strategy for spinal metastases" 26 : 298-306, 2001

7 Sundaresan N, "Surgery for solitary metastases of the spine: rationale and results of treatment" 27 : 1802-1806, 2002

8 Bartels RH, "Spinal extradural metastasis: review of current treatment options" 58 : 245-259, 2008

9 Tokuhashi Y, "Scoring system for the preoperative evaluation of metastatic spine tumor prognosis" 15 : 1110-1113, 1990

10 Sheehan JP, "Review of spinal radiosurgery: a minimally invasive approach for the treatment of spinal and paraspinal metastases" 25 : E18-, 2008

11 Hosono N, "Prognostic relevance of clinical symptoms in patients with spinal metastases" 196-201, 2005

12 Rades D, "Outcome after radiotherapy alone for metastatic spinal cord compression in patients with oligometastases" 25 : 50-56, 2007

13 Perrin RG, "Metastatic tumors of the axial spine" 4 : 525-532, 1992

14 Bhalla SK, "Metastatic disease of the spine" 73 : 52-60, 1970

15 "Metastatic Tumors of the Spine: Diagnosis and Treatment" 1 : 76-86, 1993

16 Berrettoni BA, "Mechanisms of cancer metastasis to bone" 68 : 308-312, 1986

17 Cereceda LE, "Management of vertebral metastases in prostate cancer: a retrospective analysis in 119 patients" 2 : 34-40, 2003

18 Fujita T, "Local spread of metastatic vertebral tumors, in A histologic study" 22 : 1905-1912, 1997

19 Loblaw DA, "Emergency treatment of malignant extradural spinal cord compression: an evidence-based guideline" 16 : 1613-1624, 1998

20 Maranzano E, "Effectiveness of radiation therapy without surgery in metastatic spinal cord compression: final results from a prospective trial" 32 : 959-967, 1995

21 Patchell RA, "Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial" 366 : 643-648, 2005

22 Bartels RH, "Development of a model with which to predict the life expectancy of patients with spinal epidural metastasis" 110 : 2042-2049, 2007

23 Wise JJ, "Complication, survival rates, and risk factors of surgery for metastatic disease of the spine" 24 : 1943-1951, 1999

24 Hirabayashi H, "Clinical outcome and survival after palliative surgery for spinal metastases: palliative surgery in spinal metastases" 97 : 476-484, 2003

25 Coleman RE, "Clinical features of metastatic bone disease and risk of skeletal morbidity" 12 : 6243s-6249s, 2006

26 Pittas AG, "Bone metastases from thyroid carcinoma: clinical characteristics and prognostic variables in one hundred forty-six patients" 10 : 261-268, 2000

27 Tokuhashi Y, "A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis" 30 : 2186-2191, 2005