Surgical Treatment Outcomes of Spinal Metastases of Nasopharyngeal Carcinoma: The First Report of 30 Patients from a Single Center

Figures & data

Figure 1 The patients flow diagram.

Table 1 Demographic and Clinical Characteristics of the Series (n=30)

Characteristics	Number of Cases (%)
Gender
Male	24 (80)
Female	6 (20)
Age at admission (yr)	Mean (46)
≤46	14 (46.67)
>46	16 (53.33)
Pathology type
Differentiated	17 (56.67)
Undifferentiated	13 (43.33)
Preoperative KPS
<80	13 (43.33)
≥80	17 (56.67)
Number of visceral metastasis
None	9 (30)
Single	9 (30)
Multiple	12 (40)
Metastatic level of spine
Cervical	6 (20)
Thoracic	17 (56.67)
Lumbar	6 (20)
Sacrum	1 (3.33)
Number of spine metastasis
Single	15 (50)
Multiple	15 (50)
MIT (months)
<12	14 (46.67)
≥12	16 (53.33)
Hb (g/dL)
<11	4 (13.33)
≥11	26 (86.67)
ALB (g/L)
<40	17 (56.67)
≥40	13 (43.33)
LDH (IU/L)
<245	24 (80)
≥245	6 (20)
ALP (IU/L)
<110	22 (73.33)
≥110	8 (26.67)
Ki67
<30%	10 (33.33)
≥30%	20 (66.67)
Treatment
E+A	9 (30)
P+A	11 (36.67)
D+A	10 (33.33)

Abbreviations: KPS, Karnofsky’s performance scale; MIT, metastasis interval time; Hb, hemoglobin; ALB, albumin; LDH, lactic dehydrogenase; ALP, alkaline phosphatase; E, en bloc; P, piecemeal; D, debulking; A, adjuvant therapy.

Figure 2 An illustrated SMNPC of total en bloc spondylectomy. (A) CT revealed compressed fracture at T4; (B–D) spinal cord compression and compressed T4 vertebra could be observed on MRI; (E) postoperative X-ray revealed total en bloc spondylectomy of T4 NPC and reconstruction.

Abbreviations: SMNPC, spinal metastases of nasopharyngeal carcinoma; CT, computed tomography; MRI, magnetic resonance imaging.

Figure 3 Kaplan–Meier plot showing overall survival of the 30 cases of SMNPC.

Table 2 Univariate and Multivariate Analysis of Variables for SMNPC

Characteristics	Univariate Analysis		Multivariate Analysis
	HR (95% CI)	P value	HR (95% CI)		P value
Gender
Male vs Female	1.749(0.603, 5.067)	0.303
Age (yrs)
≤46 vs >46	1.464(0.590, 3.632)	0.411
Pathology type
Di vs UD	1.936(0.745, 5.033)	0.175
Preoperative KPS
<80 vs ≥80	2.231(1.889, 5.600)	0.0874
Preoperative FS
A,B,C/D,E	4.681(1.461, 14.993)	0.0094	4.68(1.461–14.99)		0.0094*
Visceral metastasis
N vs S vs M	2.664(1.277, 5.559)	0.009	2.58(1.203–5.544)		0.015*
Metastatic level
C vs T vs L	0.899(0.496, 1.627)	0.725
Count of SMNPC
S vs M	3.185(1.074, 9.444)	0.0367
MIT
<12 vs ≥12	1.944(0.680, 5.558)	0.215
Hb (g/dL)
<11 vs ≥11	2.404(0.528, 10.94)	0.257
ALB (g/L)
<40 vs ≥40	1.377(0.480, 3.955)	0.552
LDH (IU/L)
<245 vs ≥245	1.461(0.461, 4.628)	0.519
ALP (IU/L)
<110 vs ≥110	1.204(0.425, 3.414)	0.727
Ki67
<30% vs ≥30％	2.688(1.770, 9.378)	0.0900
Surgical option
E vs P vs D/S	2.274(1.209, 4.276)	0.0108	2.31(1.136–6.421)		0.029*

Note: *Indicated statistical significance (P values ≤ 0.05).

Abbreviations: Di, differentiated; UD, undifferentiated; KPS, Karnofsky’s performance scale; FS, Frankel score; N, none; S, single; M, multiple; C, cervical; T, thoracic; L, lumbar; SMNPC, spinal metastases of nasopharyngeal carcinoma; MIT, metastasis interval time; Hb, hemoglobin; ALB, albumin; LDH, lactic dehydrogenase; ALP, alkaline phosphatase; E, total en bloc; P, total piecemeal; D/S, debulking/subtotal.

Figure 4 Kaplan–Meier curve for visceral metastasis (None/Single/Multiple).

Figure 5 Kaplan–Meier curve for preoperative FS (A, B, C/D, E).

Abbreviation: FS, Frankel score.

Figure 6 Kaplan–Meier curve for surgical option (En bloc/Total piecemeal/debulking or subtotal).