Early diagnosis and treatment is crucial for neurological recovery after surgery for metastatic spinal cord compression in prostate cancer

Figures & data

Table I. Clinical characteristics of 68 patients with prostate cancer who underwent surgery for metastatic spinal cord compression (MSCC).^a

Clinical characteristics	Hormone status
	Hormone-naïve^b (n = 15)	Hormone-refractory^c (n = 53)	P-value Naïve/ref.
Age at diagnosis of primary tumor (years)	77 (60–88)	68 (45–86)
Age at surgery for MSCC (years)	77 (60–88)	71 (54–88)
Interval between primary tumor diagnosis and surgery for MSCC (months)	0	37 (3.5–216)
Time from onset of neurological symptoms to first hospital admission (no. of pat.)^d < 1 week ≥ 1 week	9 6	26 23	0.770^e
Time from admission to local hospital to admission to cancer center (days)	2 (0–8)	1 (0–13)	0.235^f
Time from admission to cancer center to surgery (hours)	19 (4.5–68.5)	19 (3–192)	0.830^f
Time from first hospital admission to surgery (days)	3 (1–8)	2 (0–24)	0.058^f
Time from MRI scan to surgery (days)	1 (0–8)	1 (0–14)	0.994^f
High dose steroids before surgery (no. of pat.)	14	50
Surgery (no. of pat.) Posterior decompression Posterior decompression + stabilization	10 5	32 21
Adjuvant radiotherapy (no. of pat.)	13	31

^aValues are given as median (range) or absolute numbers (number of patients); ^bDiagnosed with prostate cancer as a result of pain or neurological symptoms from spinal metastasis; ^cPatients with disease progression after long-term androgen deprivation therapy; ^dData not available for four patients; ^eFisher's exact test; ^fMann-Whitney test.

Table II. Delay to surgery for spinal cord compression.^a

Delay to surgery (days)	All patients	Referred from local hospital (A)	Directly admitted to cancer center (B)	P-value^b A/B
From first admission to hospital	2 (0–24)	2 (0–24)	1 (0–4)	0.004
From MRI diagnosis	1 (0–14)	1 (0–14)	0 (0–3)	0.017
From loss of ambulation	1 (0–7)	1 (0–7)	1 (0–3)	0.107

^aData are given as median (range); ^bMann-Whitney test.

short-legendFigure 1.

Table III. Time interval between MRI and cancer center admission.

MRI	No. of patients
> 3 days prior to admission	7
3 days prior to admission	1
2 days prior to admission	3
1 day prior to admission	15
Same day as admission	36
1 day after admission	3
2 days after admission	2
> 2 days after admission	1

Table IV. Time interval between MRI and surgery.

Surgery	No. of patients
Same day as MRI	24
1 day after MRI	24
2 days after MRI	6
3 days after MRI	4
4 days after MRI	2
> 4 days after MRI	8

Table V. Clinical features influencing functional status after surgery.

Before surgery	Four weeks after surgery
	Ambulatory	Non-ambulatory	P-value
Functional status (no. of pat.) Ambulatory (n = 8) Non-ambulatory (n = 60)	8 32	0 28	0.017^a
Non-ambulatory (no. of pat.) Hormone-naïve (n = 14) Hormone-refractory (n = 46)	11 21	3 25	0.037^b
Non-ambulatory (days) Time from loss of ambulation	1 (0–3)	2 (0–7)	0.002^c

^aBefore surgery ambulatory/non-ambulatory, Fisher's exact test; ^bHormone naïve/hormone refractory, Fisher's exact test; ^cData are presented as median (range), Mann-Whitney test.

Table VI. Prognostic parameters for postoperative functional status in hormone-refractory patients that were non-ambulatory before surgery (n = 46).

Preoperative clinical feature	Four weeks after surgery
	Ambulatory	Non-ambulatory	P-value^a
Age (years) ≥ 70 < 70	11 10	16 9	0.550
PSA (ng/ml)^b ≥ 200 < 200	6 14	15 8	0.033
Time from primary PCA diagnosis (months) ≥ 36 < 36	9 12	12 13	0.774
Time from onset of neurological symptoms^c ≥ 1 week < 1 week	11 9	10 15	0.377
Time from loss of ambulation^c ≥ 48 hours < 48 hours	3 18	14 10	0.005
Anatomic distribution of MSCC^d 1 level ≥ 2 levels	15 6	15 10	0.538
Visceral metastasis absent present	15 6	16 9	0.754
Previous chemotherapy yes no	4 17	6 19	0.735
Previous radiotherapy towards operation site yes no	5 16	3 22	0.439
Karnofsky performance status (%) 80–100 ≤ 70	6 15	1 24	0.036
Surgical procedure posterior decompression posterior decompression + stabilization	9 12	19 6	0.034
Patient's way to cancer center referred from local hospital directly admitted	13 8	22 3	0.08

^aFisher's exact test, statistically significant differences presented in bold text; ^bData not available for three patients; ^cData not available for one patient; ^dMetastatic spinal cord compression.

Table VII. Series reporting treatment of metastatic spinal cord compression in prostate cancer.

Author	Year	No. of patients	Hormone-naïve PC	Type of treatment			Ambulatory patients		Regained ambulation Post-treatment	Retained ambulation Post-treatment
				S	RT	S + RT	Pre-treatment	Post-treatment
Huddart et al. [20]	1997	69	17/69		53	14	29 (42%)	46 (67%)	25/40 (63%)	21/28 (75%)
Tazi et al. [24]	2003	24	8/24		12	9	3 (13%)	15 (63%)	12/21 (57%)	3/3 (100%)
Rades et al. [22]	2006	281	37/281		281		161 (57%)	186 (66%)	40/120 (33%)	145/161 (90%)
Williams et al. [23]	2009	44	0/44	33		11	32 (73%)	36 (86%)	8/12 (67%)	26/32 (81%)
Weiss et al. [25]	2012	193	NS	193		NS^a	48 (25%)	120 (62%)	NS	NS
Crnalic et al. (present study)	2012	68	15/68	24		44	8 (12%)	40 (59%)	32/60 (53%)	8/8 (100%)

NS, not stated; PC, prostate cancer; RT, radiotherapy; S, surgery.

^aNot stated, but institutional routine is radiotherapy after surgery.

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