Cancer Management and Research (Jul 2019)
Surgical outcomes and prognostic factors for patients with gastric cancer spinal metastasis
Abstract
Nanzhe Zhong,* Ao Leng,* Shaohui He,* Minglei Yang, Dan Zhang, Jian Jiao, Wei Xu, Xinghai Yang, Jianru XiaoDepartment of Orthopedic Oncology and Spinal Tumor Center, Shanghai Changzheng Hospital, Naval Medical University, Shanghai 200003, People’s Republic of China*These authors contributed equally to this workPurpose: To investigate the outcome and prognostic factors of surgery in treating gastric cancer spinal metastasis (GCSM).Patients and methods: A total of 17 patients with GCSM who have undertaken spinal surgeries have been identified. Kaplan–Meier method and univariate analysis are adopted to investigate the prognostic factors affecting overall survival (OS) and progression-free survival (PFS).Results: The median PFS and OS are 11.3 months (95% CI: 7.8–14.9 months) and 11.9 months (95% CI: 8.4–15.4 months), respectively. Postoperatively, all patients had substantial pain relief, with mean visual analog scale score descending from 6.6±1.6 to 3.4±1.2. Meanwhile, patients also showed improved neurological functions, with 8 of them having improvements of at least one level in Frankel classification. Univariate analysis presented that patients with carcinoembryonic antigen (CEA)<6 μg/L (p=0.020), lactate dehydrogenase (LDH)<300 U/L (p=0.012), alkaline phosphatase (ALP)<200 U/L (p=0.007), and Tokuhashi score>6 (p=0.027) show longer OS. Moreover, application of bone cement, low level of ALP (<200 U/L), and LDH (<300 U/L) are associated with longer PFS (p<0.05).Conclusions: Surgery is an efficient option in treating GCSM, due to its efficacy in pain alleviation, function restoration, and stability reconstruction. Low levels of CEA, LDH, ALP, and high Tokuhashi score (>6) are all favorable factors for better OS, whereas low levels of LDH, ALP, and application of bone cement are related with longer PFS.Keywords: gastric cancer, spine metastasis, surgery
