Prognostic factors and its predictive value in patients with metastatic spinal cancer

BACKGROUND The spine is the most common location of metastatic diseases.Treating a metastatic spinal tumor depends on many factors,including patients’overall health and life expectancy.The present study was conducted to investigate prognostic factors and clinical outcomes in patients with vertebral metastases.AIM To investigate prognostic factors and their predictive value in patients with metastatic spinal cancer.METHODS A retrospective analysis of 109 patients with metastatic spinal cancer was conducted between January 2015 and September 2017.The prognoses and survival were analyzed,and the effects of factors such as clinical features,treatment methods,primary lesions and affected spinal segments on the prognosis of patients with metastatic spinal cancer were discussed.The prognostic value of Frankel spinal cord injury functional classification scale,metastatic spinal cord compression(MSCC),spinal instability neoplastic score(SINS)and the revised Tokuhashi score for prediction of prognosis was explored in patients with metastatic spinal tumors.RESULTS Age,comorbidity of metastasis from elsewhere,treatment methods,the number of spinal tumors,patient’s attitude toward tumors and Karnofsky performance scale score have an effect on the prognosis of patients(all P<0.05).With respect to classification of spinal cord injury,before operation,the proportion of grade B and grade C was higher in the group of patients who died than in the group of patients who survived,and that of grade D and grade E was lower in the group of patients who died than in the group of patients who survived(all P<0.05).At 1 mo after operation,the proportion of grade A,B and C was higher in the group of patients who died than in the group of patients who survived,and that of grade E was lower in patients in the group of patients who died than in the group of patients who survived(all P<0.05).MSCC occurred in four(14.3%)patients in the survival group and 17(21.0%)patients in the death group(P<0.05).All patients suffered from intractable pain,dysfunction in spinal cord and even paralysis.The proportion of SINS score of 1 to 6 points was lower in the death group than in the survival group,and the proportion of SINS score of 7 to 12 points was higher in the death group than in the survival group(all P<0.05).The proportion of revised Tokuhashi score of 0 to 8 points and 9 to 11 points were higher in the death group than in the survival group,and the proportion of revised Tokuhashi score of 12 to 15 points was lower in the death group than in the survival group(all P<0.05).Frankel spinal cord injury functional classification scale,MSCC,SINS and revised Tokuhashi score were important factors influencing the surgical treatment of patients with metastatic spinal cancer(all P<0.05).CONCLUSION Frankel spinal cord injury functional classification scale,MSCC,SINS and revised Tokuhashi score were helpful in predicting the prognosis of patients with metastatic spinal cancer.

Preliminary establishment of a spinal stability scoring system for multiple myeloma

BACKGROUND Multiple myeloma is an incurable malignant plasma cell disorder that represents the most common primary malignant bone tumor.It commonly involves bone metastasis in multiple vertebral bodies,and the Spinal Instability Neoplastic Score scoring system may not be fully applicable to multiple myeloma(MM)patients.AIM To evaluate the spinal stability of patients with MM spinal involvement to guide their clinical treatment.METHODS By using the Delphi method,we collected and extracted information through a series of questionnaires and improved it via feedback.We also preliminarily established a spinal stability scoring system for multiple myeloma.RESULTS Fifteen clinicians completed a second round of questionnaires and compared their answers with those of the first round of questionnaires to identify significant comments or changes that required group discussions.As a result,no further feedback was used to improve the scoring system.After integrating the information from the expert consultation questionnaire,we established the initial scoring system for MM spine stability and used the scoring system to assess a series of representative clinical cases.The MM spinal stability scoring system was created by calculating the scores of the six separate components:location,pain,number of segments,physiological curvature,comorbidities,and neurological function.The minimum value was"0",and the maximum value was"24".A score of"0-10"indicated"spine stability",a score of"11-17"indicated"potential instability",and a score of"18-24"indicated"spine instability".Patients with a score of"11-24"need an intervention such as surgery.CONCLUSION The initial establishment of the MM spine stability scoring system provides a vital theoretical basis for the evaluation of spine stability in individuals with MM.