Metastatic spinal cord compression as the first sign of malignancy

Figures & data

Table 1. Clinical characteristics of 69 patients who underwent surgery for metastatic spinal cord compression as the initial manifestation of malignancy. Values are median (range) or absolute numbers of patients

Clinical characteristics	Myeloma	Lymphoma	Prostate	Lung	Kidney	Colon	CUP^a	Other^b	Total
No. of patients	11	6	24	7	4	3	10	4	69
Female/male	5/6	2/4	0/24	4/3	1/3	1/2	4/6	1/3	18/51
Age at surgery	64	77	76	70	60.5	62	70	71.5	72
	(50–77)	(56–85)	(60–88)	(64–79)	(58–67)	(60–78)	(49–82)	(54–84)	(50–88)
Preoperative Frankel grade^c
A	0	0	0	0	0	0	0	0	0
B	0	0	1	0	0	0	0	0	1
C	3	3	18	4	2	1	7	0	38
D	8	2	5	3	1	2	3	4	28
E	0	1	0	0	1	0	0	0	2
Preoperative KPS^d, %
0–40	0	0	0	0	0	0	0	0	0
50–60	1	1	1	1	0	0	2	0	6
70	2	1	3	2	0	0	2	2	12
80–100	8	4	20	4	4	3	6	2	51
Postoperative adjuvant radiotherapy	3	2	18	5	3	2	5	2	41
Postoperative hormone treatment^e	0	0	24	0	0	0	0	0	24
Postoperative chemotherapy	10	5	4	4	3	3	1	3	33
Median postoperative survival, months	63	16	72	10	5	7	4	9	20
	(4.8–94)	(12.9–59)	(1.4–118)	(1.2–19)	(1.2–8.0)	(5–34)	(1.3–11)	(4.1–13)	(1.2–118)

a Cancer of unknown primary tumor.

b Breast cancer (n = 1), epithelioid mesothelioma (n = 1), thyroid carcinoma (n = 1), sarcoma (n = 1).

c 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.

d Karnofsky performance status scale. 100: normal, no complaints, no evidence of disease; 90: able to carry on normal activity, minor signs of symptoms of disease; 80: normal activity with effort, some signs or symptoms of disease; 70: cares for self, unable to carry on normal activity or to do any work; 60: requires occasional assistance from others but able to care for most of own needs; 50: requires considerable assistance from others and frequent medical care; 40: disabled, requires special care and assistance; 30: severely disabled, hospitalization indicated, death not imminent; 20: very sick, hospitalization necessary, active supportive treatment necessary; 10: moribund; 0: dead.

e The patients underwent surgical castration either 1–7 days before spinal surgery (7 patients), on the same day, or immediately after surgery for MSCC (15 patients); two patients received chemical castration therapy after spinal surgery.

Table 2. Anatomical location of spinal cord compression confirmed by MRI. Data are numbers of patients

Anatomical site	Anatomical distribution
	1 level	2 levels	3 levels	≥ 4 levels	Total
Cervical	2	1	O	1^a	4
Thoracic	39	11	1^b	3^c	54
Lumbar	9	1	0	0	10
Sacral	1	0	0	0	1
Total	51	13	1	4	69

Levels involved: ^a C6–Th3, ^b Th6–8, ^c Th4–6 + L3, ^c Th6–9, ^c Th8–11.

Table 3. Frankel classification of neurological function^a. Data are numbers of patients

Before surgery (n = 69)		4 weeks after surgery
		A	B	C	D	E
A	0	0	0	0	0	0
B	1	0	1	0	0	0
C	38	0	1	17	20	0
D	28	0	0	1	24	3
E	2	0	0	0	1	1

a See footnotes to Table 1.

Figure 2. Survival after surgery. A. All patients (n = 69); error bars show 95% CI. B. According to the tumor type. K: kidney cancer (n = 4); CUP: cancer of unknown primary tumor (n = 10); lung cancer (n = 7); colon cancer (n = 3); lymphoma (n = 6); myeloma (n = 11); and PCA: prostate cancer (n = 24). Other tumors not included in the graph: breast cancer (n = 1), thyroid cancer (n = 1), sarcoma (n = 1), and epithelioid mesothelioma (n = 1).