434 - Limited predictive value of scoring systems for metastatic spinal cord compression (mSCC): restrospective monocentric study

Date 28 September 2012
Event ESMO Congress 2012
Session Publication Only
Topics Supportive Care
Central Nervous System Malignancies
Presenter Emeline Tabouret
Authors E. Tabouret1, C. Cauvin2, S. Fuentes3, B. Esterni4, T. Adetchessi3, N. Salem5, A. Madroszyk2, A. Gonçalves6, P. Viens7, G. Gravis6
  • 1Neuro-oncology, Paoli Calmettes, 13009 - Marseille/FR
  • 2Medical Oncology, Institut Paoli Calmettes, Marseille/FR
  • 3Neuro-surgery, AP HM, Marseille/FR
  • 4Biostatistic, Paoli Calmette, Marseille/FR
  • 5Radiotherapy, Paoli Calmettes, Marseille/FR
  • 6Medical Oncology, Paoli Calmettes, 13009 - Marseille/FR
  • 7Cancer Center, Institute Paoli Calmettes, 13274 - Marseille CEDEX 9/FR

Abstract

Background

Incidence of MSCC is increasing, paralleling increasing life expectancy of patients (pts). We analyzed pts referred for surgery for MSCC to evaluate scoring system relevance, prognosis factors, efficiency and safety.

Methods

From 2004 to 2010 148 pts (77 men) with oncologic (84%) and hematological (16 %) diseases had surgery for MSCC. Patients and tumoral characteristics were recorded. Prognostic value of Tomita, Tokuhashi scores, ASA score, Frankel score (FS) and pain was investigated.

Results

Median age was 60 y (22–87). Lung (17%) and breast cancer (18%), were mainly represented. Multiple extra-bone metastases were observed in 39% of pts. Pain was present in 96% of pts and 66% were hyperalgic (pain score > 6). FS was decreased for 49% of pts and median Karnofsky Performance Scale (KPS) was 70%. Majority had laminectomy with spinal fixation: 73 %. Radiotherapy was done for 68%. Median overall survival (OS) was 8.9 months (IC95: 4.4–13). Tokuhashi but not Tomita score was relevant. Survival predictive accuracy of TS was only 51%. By univariate analyses, moderate pain (p = 0.001), primary breast (p = 0.02) or hematological (p < 0.001) diseases are associated with higher OS than lung cancer (p = 0.004). Absence of extra-bone metastase (p < 0.001), KPS > 70 (p < 0.001), ASA score (p < 0.001), FS (p = 0.01), type of surgery (p = 0.03), post surgery chemotherapy (p < 0.001) presented prognostic value. By multivariate analysis extra-bone metastases (p = 0.004), KPS (p = 0.001) and ASA score (p = 0.007) remained significant. Pain decrease was observed for 75% of pts. After surgery, 92% of pts were ambulatory and FS was improved for 31%. Surgery complications occurred in 16.8% and only 7% of pts died within 30 days.

Conclusion

Surgery for MSCC is associated with limited morbidity, improvement of patients' autonomy and remission of pain. In our study, usual scores seem not relevant, whereas ASA score, KPS and extra-bone metastases are significant survival prognostic factors.

Disclosure

All authors have declared no conflicts of interest.