Surgical outcomes and risk factors for poor outcomes in patients with cervical spine metastasis: a prospective study

Abstract

Background: Few studies have addressed the impact of palliative surgery for cervical spine metastasis on patients' performance status (PS) and quality of life (QOL). We investigated the surgical outcomes of patients with cervical spine metastasis and the risk factors for a poor outcome with a focus on the PS and QOL.

Methods: We prospectively analyzed patients with cervical spine metastasis who underwent palliative surgery from 2013 to 2018. The Eastern Cooperative Oncology Group PS (ECOGPS) and EuroQol 5-Dimension (EQ5D) score were assessed at study enrollment and 1, 3, and 6 months postoperatively. Neurological function was evaluated with Frankel grading. Univariate and multivariate analyses were performed to identify the risk factors for a poor surgical outcome, defined as no improvement or deterioration after improvement of the ECOGPS or EQ5D score within 3 months.

Results: Forty-six patients (mean age, 67.5 ± 11.7 years) were enrolled. Twelve postoperative complications occurred in 11 (23.9%) patients. The median ECOGPS improved from PS3 at study enrolment to PS2 at 1 month and PS1 at 3 and 6 months postoperatively. The mean EQ5D score improved from 0.085 ± 0.487 at study enrolment to 0.658 ± 0.356 at 1 month and 0.753 ± 0.312 at 3 months. A poor outcome was observed in 18 (39.1%) patients. The univariate analysis showed that variables with a P value of < 0.10 were sex (male), the revised Tokuhashi score, the new Katagiri score, the level of the main lesion, and the Frankel grade at baseline. The multivariate analysis identified the level of the main lesion (cervicothoracic junction) as the significant risk factor (odds ratio, 5.00; P = 0.025).

Conclusions: Palliative surgery for cervical spine metastasis improved the PS and QOL, but a cervicothoracic junction lesion could be a risk factor for a poor outcome.

Keywords: Cervical spine metastasis; Cervicothoracic junction; Palliative surgery; Performance status; Quality of life.

Fig. 1

Primary tumor type at surgery

Fig. 2

Kaplan–Meier survival curve

Fig. 3

PS preoperatively and at 1, 3, and 6 months postoperatively. The figures in the circles indicate the numbers of patients. The line connecting the circles shows the transition of an individual patient. The thick line represents five patients. PS, performance status

Fig. 4

EQ5D score preoperatively and at 1, 3, and 6 months postoperatively. EQ5D, EuroQol 5-Dimension

Fig. 5

Frankel grading preoperatively and at 1, 3, and 6 months postoperatively. The figures in the circles indicate the numbers of patients. The line connecting the circles shows the transition of an individual patient. The thick line represents five patients

Fig. 6

Images and clinical course of the 67-year-old man with metastatic thyroid cancer to the C5 vertebra. A Preoperative MRI: sagittal T1-weighed enhanced image at the left side and sagittal T2-weighed enhanced image at the right side. B Postoperative radiographs: posteroanterior image at the left side and lateral image at the right side. C PS, EQ5D, and Frankel grading preoperatively and at 1 and 3 months postoperatively. MRI, magnetic resonance imaging; PS, performance status; EQ5D, EuroQol 5-Dimension

Fig. 7

Images and clinical course of the 69-year-old man with metastatic hepatocellular carcinoma to the C7 vertebra. A Preoperative MRI: sagittal T1-weighed enhanced image at the left side and sagittal T2-weighed enhanced image at the right side. B Postoperative radiographs: posteroanterior image at the left side and lateral image at the right side. C PS, EQ5D, and Frankel grading preoperatively and at 1 and 3 months postoperatively. MRI, magnetic resonance imaging; PS, performance status; EQ5D, EuroQol 5-Dimension