Article

The criteria for selecting patients who may benefit from
surgery of spinal cord compression in metastatic prostate cancer are poorly
defined. We therefore studied patients operated for metastatic spinal cord
compression in order to evaluate outcome of surgery and to find predictors of
survival. METHODS: We reviewed the records of 54 consecutive
patients with metastatic prostate cancer who were operated for spinal cord
compression at Umea University Hospital. The indication for surgery was
neurological deficit due to spinal cord compression. 41 patients had
hormone-refractory cancer and 13 patients had previously untreated, hormone-naive
prostate cancer. 29 patients were operated with posterior decompression only, and
in 25 patients posterior decompression and stabilization was performed. RESULTS:
Preoperatively, 6/54 of patients were able to walk. 1 month after surgery, 33
patients were walking, 15 were non-ambulatory, and 6 had died. Mortality rate was
11% at 1 month, 41% at 6 months, and 59% at 1 year. In the hormone-naive group,
8/13 patients were still alive with a median postoperative follow-up of 26
months. In the hormone-refractory group, median survival was 5 months. Patients
with hormone-refractory disease and Karnofsky performance status (KPS) of </= 60%
had median survival of 2.5 months, whereas those with KPS of 70% and KPS of >/=
80% had a median survival of 7 months and 18 months, respectively (p < 0.001).
Visceral metastases were present in 12/41 patients with hormone-refractory tumor
at the time of spinal surgery, and their median survival was 4 months-as compared
to 10 months in patients without visceral metastases (p = 0.003). Complications
within 30 days of surgery occurred in 19/54 patients. INTERPRETATION: Our results
indicate that patients with hormone-naive disease, and those with
hormone-refractory disease with good performance status and lacking visceral
metastases, may be helped by surgery for metastatic spinal cord compression.

Langue : ANGLAIS