Spine Metastasis in Elderly

Encouraging Results for Better Survival

Quentin Beaufort, MD; Louis-Marie Terrier, MD; Arnaud Dubory, MD, PhD; Louis-Romée Le Nail, MD; Ann-Rose Cook, MD; Joseph Cristini, MD; Kévin Buffenoir, MD, PhD; Hugues Pascal-Moussellard, MD, PhD; Alexandre Carpentier, MD, PhD; Bertrand Mathon, MD; Aymeric Amelot, MD, PhD

Disclosures

Spine. 2021;46(11):751-759. 

In This Article

Abstract and Introduction

Abstract

Study Design: Multicentric prospective study.

Objective: Through this study, we aimed to clarify and update the prognostic assessment of elderly with spine metastasis (SpM).

Summary of Background Data: The incidence SpM is rising, in parallel life expectancy is getting longer and the number of elderly patients presenting malignancy is increasing. Elderly patients with SpM constitute a growing heterogeneous population

Methods: The patient data used in this study were obtained from a French national multicenter database of patients treated for SpM between 2014 and 2017. Two hundred and forty-three consecutive patients >70 years' old were diagnosed.

Results: Median overall survival (OS) time for elderly patients following the event of SpM was 16.3 months. First, we identified significantly worse survival prognostic factors for elderly patients with SpM: poor WHO status 3/4: (hazard ratio [HR]: 2.245, 95% confidence interval [CI] 1.899–2.655; P < 0.0001), >80 years (HR: 1.758, 95% CI 1.117–2.765; P = 0.015) no-ambulatory neurological status (Franckel A/B status [HR: 3.219, 95% CI 1.621–6.390; P < 0.0001)], gastrointestinal cancer (HR: 3.530, 95% CI 1.75–7.1; P < 0.0001), lung cancer (HR: 3.452, 95% CI 1.784–6.680; P < 0.0001), orthopedic brace treatment (HR: 1.329; 95% CI 1.050–1.683; P = 0.018), and epiduritis (HR: 1.52, 95% CI 1.041–2.22; P = 0.03) were independently poor prognostic factors of survival. The only good prognosis factor identified was thyroid cancer (HR: 0.257, 95% CI 0.07–0.952; P = 0.04).

Conclusion: Prognosis factors concerning the survival of elderly patients seem to be the same as those for the general population such as primary cancer histology, neurological status, WHO status, and epiduritis. Age >80 years also appears to be an independently poor prognosis factor. Our data suggest that orthopedic brace treatment is also associated with lower survival.

Level of Evidence: 2

Introduction

Cancer treatments are continuously improving, resulting in higher patient survival rates. The incidence of symptomatic spinal metastasis is increasing, in parallel life expectancy of many patients with malignancy is also rising.

Furthermore, the "elderly" represents a population group with steady growth in high-income countries.[1,2] Spinal metastasis (SpM) with or without cord compression is a debilitating and common complication of cancer. More than 20,000 new cases are reported each year in the United States.[3–5]

In 5% to 14% of patients, cancer metastasizes commonly to the spine and develops several complications associated with accelerated bone resorption, leading to increased morbidity due to pain, pathological fractures, spinal cord compressions, and infections. These complications contribute to decreased ambulatory/neurological status, quality of life and survival. The main treatment options for patients with SpM are analgesics, corticosteroids, chemotherapy, radiotherapy, and surgery.[6]

The main goal of these treatments remains discussed: they improve quality of life rather than curing patients.[7] In patients who harbor spinal epidural neoplastic metastastis, surgery is indicated for the diagnosis of the histological type of the tumor as well as segmental vertebrae instability and neurological deficits, particularly force motor deficit.[8]

Recently the Global Spine Tumour Study Group (GSTSG) showed that advanced age alone is not a contraindication for surgery.[9] However, it is also admitted that spine surgery in this specific and fragile population is at high risk of complication.[10] The potential postoperative medical complications that follow spine surgery undoubtedly interacts in the decision-making process. Thus, it is important to select patients who will benefit from surgery.

To date, a significant number of studies have attempted to identify the factors that predict positive outcomes and survival for operated SpM patients using patient's data, radiological findings, functional/neurological status, and adjuvant therapy/surgery.[11–15] Despite these assessments, the majority of these studies use a hetereogeneous dataset of patients and furthermore, to our knowledge, no studies have looked at the specific prognostic factors of survival in the elderly population. Here we present a prospective series of elderly patients aged >70 years, treated for SpM.

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