Predictive Value of the Spinal Instability Neoplastic Score for Survival and Ambulatory Function After Surgery for Metastatic Spinal Cord Compression in 110 Patients with Prostate Cancer.
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
15 Apr 2021
15 Apr 2021
Historique:
pubmed:
5
12
2020
medline:
26
5
2021
entrez:
4
12
2020
Statut:
ppublish
Résumé
We retrospectively analyzed Spinal Instability Neoplastic Score (SINS) in 110 patients with prostate cancer operated for metastatic spinal cord compression (MSCC). We aimed to investigate the association between SINS and clinical outcomes after surgery for MSCC in patients with prostate cancer. The SINS is a useful tool for assessing tumor-related spinal instability, but its prognostic value regarding survival and neurological outcome is still controversial. We analyzed 110 consecutive patients with prostate cancer who underwent surgery for MSCC. The patients were categorized according to their SINS. Patients with castration-resistant prostate cancer (CRPC, n = 84) and those with hormone-naïve disease (n = 26) were analyzed separately. In total, 106 of 110 patients met the SINS criteria for potential instability or instability (scores 7-18). The median SINS was 10 (range 6-15) for patients with CRPC and 9 (7-16) for hormone-naïve patients. In the CRPC group, the SINS was classified as stable (score 0-6) in 4 patients, as potentially unstable (score 7-12) in 70 patients, and as unstable (score 13-18) in 10 patients. In the hormone-naïve group, 22 patients met the SINS criteria for potential instability and 4 patients for instability. There was no statistically significant difference in the overall risk for death between the SINS potentially unstable and unstable categories (adjusted hazard ratio 1.3, P = 0.4), or in the risk of loss of ambulation 1 month after surgery (adjusted odds ratio 1.4, P = 0.6). The SINS is helpful in assessing spinal instability when selecting patients for surgery, but it does not predict survival or neurological outcomes. Patients with a potential spinal instability benefit equally from surgery for MSCC as do patients with spinal instability.Level of Evidence: 3.
Sections du résumé
STUDY DESIGN
METHODS
We retrospectively analyzed Spinal Instability Neoplastic Score (SINS) in 110 patients with prostate cancer operated for metastatic spinal cord compression (MSCC).
OBJECTIVE
OBJECTIVE
We aimed to investigate the association between SINS and clinical outcomes after surgery for MSCC in patients with prostate cancer.
SUMMARY OF BACKGROUND DATA
BACKGROUND
The SINS is a useful tool for assessing tumor-related spinal instability, but its prognostic value regarding survival and neurological outcome is still controversial.
METHODS
METHODS
We analyzed 110 consecutive patients with prostate cancer who underwent surgery for MSCC. The patients were categorized according to their SINS. Patients with castration-resistant prostate cancer (CRPC, n = 84) and those with hormone-naïve disease (n = 26) were analyzed separately.
RESULTS
RESULTS
In total, 106 of 110 patients met the SINS criteria for potential instability or instability (scores 7-18). The median SINS was 10 (range 6-15) for patients with CRPC and 9 (7-16) for hormone-naïve patients. In the CRPC group, the SINS was classified as stable (score 0-6) in 4 patients, as potentially unstable (score 7-12) in 70 patients, and as unstable (score 13-18) in 10 patients. In the hormone-naïve group, 22 patients met the SINS criteria for potential instability and 4 patients for instability. There was no statistically significant difference in the overall risk for death between the SINS potentially unstable and unstable categories (adjusted hazard ratio 1.3, P = 0.4), or in the risk of loss of ambulation 1 month after surgery (adjusted odds ratio 1.4, P = 0.6).
CONCLUSION
CONCLUSIONS
The SINS is helpful in assessing spinal instability when selecting patients for surgery, but it does not predict survival or neurological outcomes. Patients with a potential spinal instability benefit equally from surgery for MSCC as do patients with spinal instability.Level of Evidence: 3.
Identifiants
pubmed: 33273445
pii: 00007632-202104150-00016
doi: 10.1097/BRS.0000000000003835
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
550-558Informations de copyright
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Références
Bubendorf L, Schöpfer A, Wagner U, et al. Metastatic patterns of prostate cancer: an autopsy study of 1,589 patients. Hum Pathol 2000; 31:578–583.
Crnalic S, Hildingsson C, Wikstrom P, Bergh A, Löfvenberg R, Widmark A. Outcome after surgery for metastatic spinal cord compression in 54 patients with prostate cancer. Acta Orthop 2012; 83:80–86.
Wänman J, Grabowski P, Nyström H, et al. Metastatic spinal cord compression as the first sign of malignancy. Acta Orthop 2017; 88:457–462.
Patchell RA, Tibbs PA, Regine WF, et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet 2005; 366:643–648.
Finkelstein JA, Zaveri G, Wai E, Vidmar M, Kreder H, Chow E. A population-based study of surgery for spinal metastases. Survival rates and complications. J Bone Joint Surg Br 2003; 85:1045–1050.
Crnalic S, Löfvenberg R, Bergh A, Widmark A, Hildingsson C. Predicting survival for surgery of metastatic spinal cord compression in prostate cancer: a new score. Spine (Phila Pa 1976) 2012; 37:2168–2176.
Clarke MJ, Molina CA, Fourney DR, et al. Systematic review of the outcomes of surgical treatment of prostate metastases to the spine. Global Spine J 2017; 7:460–468.
Fisher CG, DiPaola CP, Ryken TC, et al. A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group. Spine (Phila Pa 1976) 2010; 35:E1221–E1229.
Fourney DR, Frangou EM, Ryken TC, et al. Spinal instability neoplastic score: an analysis of reliability and validity from the spine oncology study group. J Clin Oncol 2011; 29:3072–3077.
Campos M, Urrutia J, Zamora T, et al. The Spine Instability Neoplastic Score: an independent reliability and reproducibility analysis. Spine J 2014; 14:1466–1469.
Fisher CG, Versteeg AL, Schouten R, et al. Reliability of the Spinal Instability Neoplastic Scale among radiologists: an assessment of instability secondary to spinal metastases. Am J Roentgenol 2014; 203:869–874.
Huisman M, Van der Velden JM, Van Vulpen M, et al. Spinal instability as defined by the spinal instability neoplastic score is associated with radiotherapy failure in metastatic spinal disease. Spine J 2014; 14:2835–2840.
Bollen L, Groenen K, Pondaag W, et al. Clinical evaluation of the Spinal Instability Neoplastic Score in patients treated with radiotherapy for symptomatic spinal bone metastases. Spine (Phila Pa 1976) 2017; 42:E956–E962.
Crnalic S, Hildingsson C, Bergh A, Widmark A, Svensson O, Löfvenberg R. Early diagnosis and treatment is crucial for neurological recovery after surgery for metastatic spinal cord compression in prostate cancer. Acta Oncol 2013; 52:809–815.
Nordstrand A, Bovinder Ylitalo E, Thysell E, et al. Bone cell activity in clinical prostate cancer bone metastasis and its inverse relation to tumor cell androgen receptor activity. Int J Mol Sci 2018; 19:1223.
Hussain I, Barzilai O, Reiner AS, et al. Patient-reported outcomes after surgical stabilization of spinal tumors: symptom-based validation of the Spinal Instability Neoplastic Score (SINS) and surgery. Spine J 2018; 18:261–267.
Zadnik PL, Hwang L, Ju D, et al. Prolonged survival following aggressive treatment for metastatic breast cancer in the spine. Clin Exp Metastasis 2014; 31:47–55.
Zadnik PL, Goodwin CR, Karami KJ, et al. Outcomes following surgical intervention for impending and gross instability caused by multiple myeloma in the spinal column. J Neurosurg Spine 2015; 22:301–309.
Amelot A, Moles A, Cristini J, et al. Predictors of survival in patients with surgical spine multiple myeloma metastases. Surg Oncol 2016; 25:178–183.
Masuda K, Ebata K, Yasuhara Y, Enomoto A, Saito T. Outcomes and prognosis of neurological decompression and stabilization for spinal metastasis: is assessment with the spinal instability neoplastic score useful for predicting surgical results? Asian Spine J 2018; 12:846–853.
Barzilai O, Versteeg AL, Goodwin CR, et al. Association of neurologic deficits with surgical outcomes and health-related quality of life after treatment for metastatic epidural spinal cord compression. Cancer 2019; 125:4224–4231.
Roudier MP, Morrissey C, True LD, Higano CS, Vessella RL, Ott SM. Histopathological assessment of prostate cancer bone osteoblastic metastases. J Urol 2008; 180:1154–1160.
Keller ET, Brown J. Prostate cancer bone metastases promote both osteolytic and osteoblastic activity. J Cell Biochem 2004; 91:718–729.