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Spine (Phila Pa 1976). 2020 Feb 10. doi: 10.1097/BRS.0000000000003415. [Epub ahead of print]

Prognostic Factors in the New Katagiri Scoring System after Palliative Surgery for Spinal Metastasis.

Author information

1
Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan.
2
Department of Orthopaedic Surgery, Japanese Red Cross Nagoya Daini Hospital, 2-9, Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan.
3
Department of Orthopaedic Surgery, Konan Kosei Hospital, 137, Omatsubara, Takaya-cho, Konan, Aichi, 483-8704, Japan.
4
Department of Orthopaedic Surgery, Toyohashi Municipal Hospital, 50, Aza Hachiken Nishi, Aotake-Cho, Toyohashi, Aichi, 441-8570, Japan.
5
Department of Orthopaedic Surgery, Aichi Medical University Hospital, 1-1, Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
6
Department of Orthopaedic Surgery, Chubu Rosai Hospital, 1-10-6, Komei, Minato-ku, Nagoya, 455-8530, Japan.

Abstract

STUDY DESIGN:

Retrospective study.

OBJECTIVE:

The purpose of the study was to examine survival after surgery for a metastatic spinal tumor using prognostic factors in the new Katagiri score.

SUMMARY OF BACKGROUND DATA:

Surgery for spinal metastasis can improve quality of life and facilitate treatment of the primary cancer. However, choice of therapy requires identification of prognostic factors for survival, and these may change over time due to treatment advances. The new Katagiri score for the prognosis of skeletal metastasis includes classification of the primary tumor site and the effects of chemotherapy and hormonal therapy.

METHODS:

The subjects were 201 patients (127 males, 74 females) who underwent surgery for spinal metastases at 6 facilities in the Nagoya Spine Group. Age at surgery, gender, follow-up, metastatic spine level, primary cancer, new Katagiri score (including primary site, visceral metastasis, laboratory data, performance status (PS), and chemotherapy) and survival were obtained from a prospectively maintained database.

RESULTS:

Posterior decompression (n = 29) and posterior decompression and fixation with instrumentation (n = 182) were performed at a mean age of 65.9 (range, 16-85) years. Metastasis was present in the cervical (n = 19, 10%), thoracic (n = 155, 77%), and lumbar (n = 26, 13%) spine, and sacrum (n = 1, 1%). In multivariate analysis, moderate growth (HR 2.95, 95% CI, 1.27-7.89, P < 0.01) and rapid growth (HR 4.71, 95% CI, 2.78-12.31, P < 0.01) at the primary site; nodular metastasis (HR 1.53, 95% CI, 1.07-3.85, P < 0.01) and disseminated metastasis (HR 2.94, 95% CI, 1.33-5.42, P < 0.01); and critical laboratory data (HR 3.15, 95% CI, 2.06-8.36, P < 0.01) and poor PS (HR 2.83, 95% CI, 1.67-4.77, p < 0.01) were significantly associated with poor survival.

CONCLUSION:

Accurate prognostic factors are important in deciding the treatment strategy in patients with spinal metastasis, and our identification of these factors may be useful for these patients.

LEVEL OF EVIDENCE:

3.

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