Postoperative survival and functional outcome of palliative decompression and stabilization for thoracic metastatic spinal cord compression: prognostic factor analysis

Objective: To analyze the survival time and functional outcome of patients with thoracic metastatic spinal cord compression (MSCC) after operation and to identify parameters influencing the postoperative survival time. Methods: Sixty-seven consecutive patients with thoracic MSCC who were performed with posterior decompression and spine stabilization from January 2010 to December 2014 were retrospectively in this study. Nine prognostic factors, namely, age, primary tumor, preoperative Eastern Cooperative Oncology Group (ECOG) performance status, interval from cancer diagnosis to spinal metastases, preoperative ambulatory status, preoperative visceral metastases, number of extraspinal bone metastasis, number of involved vertebrae, and postoperative adjuvant radiotherapy, were investigated. All factors were analyzed by Kaplan-Meier method and Cox proportional hazards model. Results: Postoperative Frankel grade was improved in 52% patients, maintained in 43% and retrogressive in 5%. Postoperative ambulatory rate was significantly higher than the preoperative ambulatory rate (P < 0.001). VAS score decreased from preoperative 5.7 ± 1.7 to postoperative 2.1 ± 1.4 score (P < 0.01). Surgery-related complications occurred in 13.4% (9/67) patients. In the multivariate Cox regression analysis, age, type of primary tumor, preoperative visceral metastases, preoperative ECOG-PS, and postoperative adjuvant radiotherapy were independent prognostic factors for survival in patients with MSCC after surgery. Conclusions: Posterior decompression and stabilization is a relatively safe and effective method for MSCC. Besides, our study showed that age, type of primary tumor, preoperative visceral metastases, preoperative ECOG-PS, and postoperative adjuvant radiotherapy were independent characteristics for postoperative survival.