Incidence and risk factors associated with the development of metastatic spinal cord compression due to bone metastasis in women with cervical cancer.

PURPOSE: The aim of this study was to determine the incidence and factors associated with the development of metastatic spinal cord compression (MSCC) after cervical cancer (CC). METHODS: This retrospective cohort of 3551 women with CC who underwent treatment at the Brazilian National Cancer Institute were included in the study. Clinical and sociodemographic variables were obtained from the Hospital Cancer Registry and from hospital records. A descriptive study of the population was carried out, using means and standard deviations or frequencies and percentages. The Kaplan-Meier curve was used to identify annual incidence rates. Associations between the independent variables and the outcome (MSCC) were evaluated by a univariate analysis, applying crude and adjusted odds ratios (aOR) assuming 95% confidence intervals. RESULTS: The MSCC incidence was of 1.5% (n = 51), associated to advanced staging (aOR = 2.65, 95% CI: 1.45-4.85, p = 0.001) and initial treatment with concomitant chemotherapy and radiotherapy (aOR = 4.40, 95% CI: 1.74-11.13, p = 0.002). CONCLUSIONS: Our findings revealed the incidence and factors associated with MSCC, indicating a subset of patients who may be potential targets for the prevention and early treatment of this condition, indicating unprecedented and relevant data for the Brazilian epidemiological scenario due to the high CC incidence rates.

Predictors of overall survival in non-small-cell lung cancer patients with metastatic spinal cord compression treated with short-course radiotherapy.

Metastatic spinal cord compression (MSCC) is a condition that impacts directly on the patient's prognosis. OBJECTIVE: The study purpose was to identify predictors of overall survival in non-small-cell lung cancer (NSCLC) patients with MSCC. METHODS: A cohort study involving NSCLC patients enrolled between 2008 and 2017 was performed. Sixty-four patients treated with short-course radiotherapy were included. Clinical and socio-demographic data were extracted from medical records. Data were analysed using survival analysis and Cox proportional hazard regression analysis. RESULTS: The median survival time was 2.5 months (95% CI: 1.6-3.5). Patients >60 years had shorter survival than younger patients (HR 1.85; 95% CI 1.06-3.24; p = 0.02), and patients with performance status (PS) >2 had shorter survival than those with PS≤2 (HR 1.93; 95% CI 1.12-3.33; p = 0.01). CONCLUSION: This study found worse PS and higher age are independent predictors of overall survival in NSCLC patients with MSCC treated with short-course radiotherapy after adjusting the potential confounding factors (PS, age and target therapy).

A management algorithm for vertebral destruction syndrome by multiple myeloma and metastatic spinal cord compression.

INTRODUCTION: Multiple myeloma represents 1% of all cancers and 10% of hematological cancers. Up to 80-90% of cases will have skeletal involvement and the spine is the most frequently involved site. Any intervention must be aimed to improve the patients functional prognosis and will impact their quality of life. OBJECTIVE: To describe the clinical presentation of vertebral destruction syndrome due to multiple myeloma and to present the management algorithm used for the study and decision-making in treatment. MATERIAL AND METHODS: Study design: Retrospective cross-sectional. A search was made in the hospitals clinical file in search of patients with a histological diagnosis of multiple myeloma attended by the Spinal Surgery Service. Clinical characteristics of the initial presentation were obtained such as: presence of pain, ASIA scale and it was categorized according to the Durie-Salmon classification at diagnosis; the levels involved and type of surgery were described. RESULTS: The study included ten patients with an average age of 61.4 years, 70% were male subjects. All patients were approach according to the modified protocol for vertebral destruction syndrome and fluoroscopy-guided percutaneous biopsy. Most had pain at diagnosis, after neurologic examination only 30% were classified as ASIA A. Most of the patients were staged III according to Durie Salomon. The most frequently vertebral segment involved was thoracic. In only one patient more than two vertebrae were involved. After diagnosis of multiple myeloma, nine patients were managed according to a NOMS framework. In the majority they were treated with fusion by posterior approach, six of them were augmented with vertebroplasty. Only one patient of the total, was treated with vertebroplasty alone. CONCLUSIONS: The use of systematized management algorithms will allow better decisions to be made in conjunction with a multidisciplinary group for the care of multiple myeloma with vertebral involvement.

INTRODUCCIÓN: El mieloma múltiple representa 1% de todos los tipos de cáncer y 10% de los cánceres hematológicos. Hasta en 80-90% de los casos se involucrará el sistema esquelético, siendo la columna el sitio más frecuentemente afectado. Cualquier intervención planeada deberá ser dirigida a mejorar el pronóstico funcional del paciente e impactará en su calidad de vida. OBJETIVO: Describir la presentación clínica del síndrome de destrucción vertebral por mieloma múltiple y presentar el algoritmo de manejo empleado para el estudio y la toma de decisiones en el tratamiento. MATERIAL Y MÉTODOS: Diseño de estudio: Retrospectivo, transversal. Se realizó una búsqueda en el archivo clínico del hospital en búsqueda de pacientes con diagnóstico histológico de mieloma múltiple atendidos por el Servicio de Cirugía de Columna. Se obtuvieron características clínicas de la presentación inicial como: presencia de dolor, escala de ASIA y se categorizó de acuerdo con la clasificación de Durie-Salmon al diagnóstico; se describen los niveles involucrados y tipo de cirugía. RESULTADOS: El estudio incluyó 10 pacientes con una edad promedio de 61.4 años, 70% de los cuales fueron varones. Todos los pacientes se abordaron de acuerdo al protocolo de síndrome de destrucción vertebral y con biopsia percutánea guiada por fluoroscopía. La mayoría de los pacientes tenían dolor al diagnóstico, tras la exploración neurológica sólo el 30% fueron clasificados como ASIA A. La mayoría de los pacientes se estadificaron como III de acuerdo con Durie-Salmon. El segmento vertebral más comúnmente afectado fue el torácico. En sólo un paciente se involucraba más de dos vértebras. Tras el diagnóstico de mieloma múltiple, nueve pacientes fueron manejados de acuerdo con el marco de trabajo NOMS. La mayoría fueron tratados con fusión por un abordaje posterior, seis de ellos con aumentación con vertebroplastía. Sólo un paciente del total, fue tratado sólo con vertebroplastía. CONCLUSIONES: El empleo de algoritmos de tratamiento sistematizado permitirá la toma de mejores decisiones en conjunto con un grupo multidisciplinario para el tratamiento de mieloma múltiple con afección vertebral.

Functional status of patients with metastatic spinal cord compression.

PURPOSE: This prospective study was conducted to evaluate the functional status and clinical features of inpatients with metastatic spinal cord compression and to explore possible associated factors and the correlation with neurological deficits. METHODS: Cases were identified through an active search in the hospital units of the National Cancer Institute. For 47 patients, clinical and demographic characteristics were collected; functional status was measured by the Functional Independence Measure; modified Tokuhashi score was used to predict survival time; neurological deficits were measured using the American Spinal Injury Association Impairment Scale; and general condition was evaluated using the Karnofsky Performance Status Scale. The correlation between the level of neurological deficits and functional status was calculated using the Spearman correlation test. The difference in the functional independence score according to neurological status was assessed with the Kruskall-Wallis test. RESULTS: The degree of functional status was associated with Karnofsky Performance Status, level of neurological deficits, ability to walk, survival time, and skin color (p < 0.05). There was difference in the functional status (p = 0.004) and in the motor domain (p = 0.001) according to the level of neurological deficits. The correlation of the Functional Independence Measure with level of neurological deficits and with Karnofsky Performance Status was moderate (r = 0.46, p < 0.02). CONCLUSION: The Functional Independence Measure was adequate for evaluating the functional status of patients with metastatic spinal cord compression. Palliative rehabilitation should be integrated early and strategies should be linked to the prognosis of survival.

Is there a correlation between the spinal instability neoplastic score and mechanical pain in patients with metastatic spinal cord compression? A prospective cohort study.

INTRODUCTION: The decision for selecting patients for surgical treatment of metastatic spinal cord compression (MSCC) is challenging even for experienced surgeons. Recently, the spinal instability neoplastic score (SINS) has been proposed to help surgeons in the evaluation of spinal stability in the setting of spinal metastases. This study aimed to evaluate the correlation between SINS and preoperative visual analog scale (VAS), as well as the pre- and post-operative association of the VAS and neurological function. METHODS: A prospective cohort study was conducted in a tertiary referral cancer center. Seventy-nine patients with MSCC were surgically treated from June 2012 to March 2015. Pain status before and after surgery was assessed using VAS score, and neurological status was evaluated using the American Spine Injury Association Impairment Scale (AIS) before and after surgery. Pain was classified as VAS (0-4) none or mild pain; VAS (5-8) moderate pain; and VAS (9-10) as severe pain. Neurological function was scored as AIS A: Complete deficits, AIS B-D: Incomplete deficits, AIS E: Neurologically intact. SINS degrees were classified as 0-6-stable; 7-12 potentially unstable, and 13-18-unstable. Spearman's correlation coefficient test was utilized for correlation between pain and SINS; Chi-square association test was utilized for evaluating pre- and post-operative pain and AIS, as well as the association between SINS and tumor types. RESULTS: A higher SINS correlates with severe mechanical pain preoperatively (ρ = 0.38, P = 0.001); surgical procedure improved neurological function (P = 0.0001), and decrease pain (P = 0.84). Finally, a higher SINS was also associated with osteolytic tumors (P = 0.03). CONCLUSIONS: The SINS correlates with mechanical pain. Surgery provides a significant improvement in pain and neurological status, especially in patients who presented higher SINS scores and some degree of preoperative neurological function.

Impact of Symptomatic Metastatic Spinal Cord Compression on Survival of Patients with Non-Small-Cell Lung Cancer.

OBJECTIVES: Non-small-cell lung cancer (NSCLC) is one of the most common primary tumor sites among patients with metastatic spinal cord compression (MSCC). This disorder is related to neurologic dysfunction and can reduce the quality of life, but the association between MSCC and death is unclear. The aim of this study was to analyze the impact of the occurrence of symptomatic MSCC on overall survival of patients with NSCLC. METHODS: A cohort study was carried out involving 1112 patients with NSCLC who were enrolled between 2006 and 2014 in a single cancer center. Clinical and sociodemographic data were extracted from the physical and electronic records. Survival analysis of patients with NSCLC was conducted using the Kaplan-Meier method. A log-rank test was used to assess differences between survival curves. Cox proportional hazards regression analyses were carried out to quantify the relationship between the independent variable (MSCC) and the outcome (overall survival). RESULTS: During the study period, the incidence of MSCC was 4.1%. Patients who presented with MSCC were 1.43 times more likely to die than were those with no history of MSCC (hazard ratio, 1.43; 95% confidence interval [CI], 1.03-2.00; P = 0.031). The median survival time was 8.04 months (95% CI, 6.13-9.96) for those who presented MSCC and 11.95 months (95% CI, 10.80-13.11) for those who did not presented MSCC during the course of disease (P = 0.002). CONCLUSIONS: MSCC is an important and independent predictor of NSCLC worse survival. This effect was not influenced by sociodemographic and clinical factors.

Prognostic factors in patients with metastatic spinal cord compression secondary to lung cancer: a systematic review of the literature.

PURPOSE: The Metastatic spinal cord compression (MSCC) secondary to lung cancer (LC) has worse prognosis when compared to MSCC related to other solid tumors. The purpose of this study is to identify the survival time and the prognostic factors in the MSCC secondary to LC. METHODS: A systematic review of the literature has been carried out. Studies published between January 2005 and March 2015 were identified through the electronic database PubMed and LILACS. Two independent reviewers selected the articles. RESULTS: 7 studies were identified, which met the inclusion criteria, involving 1010 patients. The survival in 6 and 12 months ranged between 18 and 61%, and between 3.8 and 32%, respectively. The median survival ranged between 2.8 and 9 months. The variables related to the survival improvement were: female, performance status 1 or 2, pre-radiotherapy and postoperative ambulatory status, absence of bone metastases and visceral metastases, interval from cancer diagnosis to spinal metastases or radiotherapy of MSCC>15 months, slower (>7 days) development of motor deficit, and the neurological status at the postoperative. CONCLUSIONS: The prognosis of the MSCC secondary to LC was poor. Considering the small number of studies identified, further research is needed to identify prognostic factors that are independent of the MSCC secondary to LC.

Incidence, associated factors, and survival in metastatic spinal cord compression secondary to lung cancer.

BACKGROUND CONTEXT: Bone metastasis (BM) occurs frequently in patients with lung cancer (LC). The most affected are the bones of the spine, increasing the risk of developing metastatic spinal cord compression (MSCC). Although MSCC is one of the most disabling complications, few studies have reported relevant results related to its frequency and prognosis among patients with LC. PURPOSE: The purpose of this study was to determine the incidence and associated factors of the development of MSCC after BM with LC and its prognosis. STUDY DESIGN/SETTING: This is a cohort study. PATIENT SAMPLE: A cohort of 112 patients with BM because of LC, whose treatment was performed exclusively at the National Cancer Institute, was analyzed. OUTCOME MEASURES: Study outcome measures included incidence of MSCC, factors associated with MSCC, and survival analysis. METHODS: A cohort study was performed involving patients with BM because of LC diagnosed between 2007 and 2011. Clinical and sociodemographic data were extracted from the physical and electronic medical records because of initial diagnosis (up until December 2013). The association between the independent variables and the outcomes was performed by using crude and adjusted odds ratios (ORs), assuming 95% confidence intervals (CIs). For the exploratory evaluation between the independent variables and the time until the outcomes, Kaplan-Meier survival analysis was conducted. To identify if the differences between the curves were statistically significant, a log-tank test was calculated. A Cox multiple regression model, using the forward stepwise method, was applied, aiming to estimate the factors associated with time to death in the different exposure groups. RESULTS: Of the 112 patients with BM, 31 (27.7%) developed MSCC. The univariate analysis showed that patients with three or more involved vertebrae revealed a 6.1 times greater risk of developing MSCC, compared with those with up to two metastatic vertebrae involved (OR: 6.1, 95% CI: 2.5-15.1, p<.001). Among the patients who developed MSCC, the median survival time was 4.4 months (95% CI: 1.5-7.3) and 4.7 months (95% CI: 3.5-5.9) in the patients without MSCC, not being a statistically significant difference (p=.19). After the occurrence of the MSCC, the median survival time was 2.8 months (95% CI: 1.4-4.1). CONCLUSIONS: In this study, a high incidence of MSCC was observed in patients with BM. The study suggests that patients with three or more involved vertebrae per metastasis are more likely to develop MSCC. No alteration in the overall survival time was noticed among the patients with or without MSCC.