Outcome after surgery for metastatic spinal cord compression in 54 patients with prostate cancer

Figures & data

Table 1. Clinical characteristics of 54 patients with prostate cancer who were operated for metastatic spinal cord compression (SCC) a

		Hormone status
		Hormone-naïve ^b	Hormone-refractory ^c
Clinical characteristics		(n = 13)	(n = 41)
Age at diagnosis of primary tumor		77 (60–85)	69 (51–86)
Age at surgery for SCC		77 (60–85)	72 (54–88)
PSA at diagnosis of primary tumor (ng/mL)		140 (21–4,000)	82 (2–7,300)
PSA at surgery for SCC (ng/mL)		140 (21–3,704)	190 (0.5–5,139) ^d
Interval between primary tumor diagnosis and surgery for SCC (months)		0	34 (3.5–216)
Gleason score of primary tumor:	6	0	2
	7	1	14
	8	1	6
	9	1	6
	10	0	3
	Not available	10	10
Other sites of metastasis at the time of surgery for SCC ^e
Abdominal organs		0	3
Pelvic organs		0	3
Lymph nodes		0	9
Lung		0	3
Other bones		11	41
Preoperative Frankel grade: ^f	A	0	0
	B	0	3
	C	12	33
	D	1	5
	E	0	0

^a Values are given as median (min–max) or absolute numbers (number of patients).

^b Diagnosed with prostate cancer as a result of pain or neurological symptoms from spinal metastasis.

^c Patients with disease progression after long-term androgen deprivation therapy.

^d PSA values were not available for 3 patients.

^e Visceral metastases were registered in 12 patients in the hormone-refractory group.

Patients may have more than one metastasis.

^f Grade A: complete lesion (paraplegia); grade B: only sensory function; grade C: motor function present but not of practical use (non-ambulatory); grade D: motor function present, sufficient to allow walking (ambulatory); grade E: no neurological symptoms.

Table 2. Anatomic localization of spinal cord compressiona

Anatomical site	Anatomical distribution
	1 level	2 levels	3 levels	4 levels
Cervical		1
Thoracic	28	14 ^b	1	1 ^c
Lumbar	7	2

^a Data represent number of patients.

^b In two patients, 2 separate levels were involved: Th4 + Th8, and Th6 + Th9, respectively.

^c Levels involved: C7-Th3.

Table 3. Neurological evaluation using the Frankel^a classification: preoperative values compared with those recorded 4 weeks postoperatively

	Pre-op.	4 weeks post-op.
	n=54 ^b	A	B	C	D	E	Dead
Hormone-refractory
A
B	3 ^b			2			1
C	33 ^b			10	18		5
D	5				5
E
Hormone-naive
A
B
C	12			3	9
D	1				1
E

^aSee legends to Table 1.

^b 6 patients with hormone refractory tumors died within 4 weeks after operation and are not included in 4 weeks postoperative evaluation.

Table 4. Complications of surgery for metastatic spinal cord compression that were registered in 19 of 54 patients within 30 days of surgery (patients may have more than one complication)

Systemic complications	n ^a	n ^b	Follow-up after surgery
Thromboembolic: stroke		1	3 months died
Pulmonary: pneumonia	1	2	1 ^b and 5 ^a months died; and 14 ^b months alive
embolism		1	7 months alive
Septicemia	1		12 days died
Gastrointestinal:
intestinal rupture	1		10 days died
bleeding		1	12 days died
Multiple organ failure	2	1	5 ^a, 16 ^b, and 28 ^a days died
Local complications	n ^a	n ^b	Revised ^c	Follow-up after surgery
Superficial wound infection	3	2	1 ^b	2 ^a, 5 ^a, 7 ^b, and 16 ^a months died; and 14 ^b months alive
CSF leak	1	1	1 ^a,d	4 ^a months died; and 14 ^b months alive
Wound dehiscence	1	1	2	4 ^a and 7 ^b months died
Sacral pressure sores	3	1	2 ^a	1 ^a,e , 1.5 ^b , 2 ^a , and 10 ^a months died

^a Posterior decompression.

^b Posterior decompression and stabilization.

^c In all cases, local surgical wound revision was performed, and in the patient with CSF leakage the dural rift was sutured and the wound was covered with musculocutaneous flap.

^d Revised twice.

^e Patient was also operated for pathological fracture of the left femur 10 days after spinal surgery.

Figure 1. Survival for the patients with hormone-naïve (n = 13) and hormone-refractory (n = 41) prostate cancer after surgery for spinal cord compression (left), and after diagnosis of the primary tumor (right).

Figure 2. Survival for the patients with hormone-refractory prostate cancer (n = 41) according to Karnofsky performance status ^a,b (KPS) (left), and presence of visceral metastasis (right).

Figure 3. Survival for the patients with hormone-refractory prostate cancer (n = 35) ^a according to ambulatory status 4 weeks after surgery for spinal cord compression.