A validated preoperative score predicting survival and functional outcome in lung cancer patients operated with posterior decompression and stabilization for metastatic spinal cord compression

Abstract

PURPOSE: This study aims to create and validate a score for survival and functional outcome of lung cancer patients with metastatic spinal cord compression (MSCC) after posterior decompressive surgery. METHODS: The entire cohort of 73 consecutive patients was randomly assigned to a test group (N = 37) and a validation group (N = 36). In the test group, we retrospectively analyzed 10 preoperative characteristics. Characteristics significantly associated with survival on multivariate analysis were included in the score. Patients in the validation group were used to confirm whether the score was reproducible. Postoperative functional outcome was analyzed both in the test and validation groups. RESULTS: On multivariate analysis, preoperative ambulatory status (P = 0.0017), visceral metastases (P = 0.0002), and time developing motor deficits (P = 0.0004) had significant impact on survival and were included in the scoring system. According to the prognostic scores, which ranged from 0 to 6 points, two risk groups were designed: 0-2 and 3-6 points and the median survival was 2.6 months (95 % CI, 1.0-3.8 months) and 10.7 months (95 % CI, 7.1-13.7 months), respectively (P < 0.0001). In the validation group, the corresponding median survival was 2.7 months (95 % CI, 1.6-5.5 months) and 10.8 months (5.8-13.6 months), respectively (P < 0.0001). In addition, the functional outcome was worse in patients with 0-2 points than in patients with 3-6 points both in the test (P = 0.0023) and validation groups (P = 0.0298). CONCLUSION: Patients with scores of 0-2 points, who have short survival time (life expectancy less than 3 months) and poor functional outcome, appear best treated with radiotherapy or best supportive care alone. Surgery may be no longer in consideration in most of the patients in this group. Patients with score of 3-6 points should be surgical candidates, because survival prognosis (life expectancy more than 10 months) and functional outcome are favorable after surgery.