Metastatic spinal cord compression as the first manifestation of malignancy: A retrospective study of surgical outcome from single institution

Ue-Cheung Ho; Dar-Ming Lai; Fu-Ren Xiao; Shih-Hung Yang; Chang-Mu Chen; Fon-Yih Tsuang

doi:10.1016/j.asjsur.2023.08.159

Metastatic spinal cord compression as the first manifestation of malignancy: A retrospective study of surgical outcome from single institution

Asian J Surg. 2023 Sep 7:S1015-9584(23)01334-9. doi: 10.1016/j.asjsur.2023.08.159. Online ahead of print.

Authors

Ue-Cheung Ho¹, Dar-Ming Lai², Fu-Ren Xiao², Shih-Hung Yang², Chang-Mu Chen², Fon-Yih Tsuang³

Affiliations

¹ Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei City, Taiwan; Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, Yunlin County, Taiwan; Spine Tumor Center, National Taiwan University Hospital, Taipei City, Taiwan.
² Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei City, Taiwan; Spine Tumor Center, National Taiwan University Hospital, Taipei City, Taiwan.
³ Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei City, Taiwan; Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, Yunlin County, Taiwan; Spine Tumor Center, National Taiwan University Hospital, Taipei City, Taiwan. Electronic address: tsuangfy@ntu.edu.tw.

PMID: 37689519
DOI: 10.1016/j.asjsur.2023.08.159

Abstract

Background: Given the limited studies addressing the issue about the effect of different surgical modalities for metastatic spinal cord compression (MSCC) as the first malignancy manifestation, we conducted a retrospective case-control study to evaluate the surgical outcome of MSCC as the first malignancy manifestation.

Methods: A total of 128 patients who were suspected of having metastatic spinal cord compression and underwent surgery from 2008 to 2021 were enrolled in the study. All patients were categorized into either 'debulking group' or 'palliative group'.

Results: The primary outcome was progression-free survival (PFS). The secondary outcomes were overall survival (OS), Frankel scale, and Karnofsky scores. All the outcomes were analyzed with a data cutoff of December 31, 2021. There was a significant difference between groups in progression-free survival (PFS) (p = 0.0094). However, there was no significant difference between groups in the overall survival (OS) (p = 0.0746). Age of onset, gender, duration of symptoms, and location of spinal metastasis, initial Frankel, initial Tomita scores, and initial Karnofsky performance scale showed no significant differences between groups.

Conclusion: In conclusion, debulking surgery was shown to provide better neurological recoveries and could be considered first in patients with metastatic spinal cord compression as the first malignancy manifestation.

Keywords: Debulking surgery; Frankel scale; Metastatic spinal cord compression; Palliative surgery; Tomita score.