The Impact of Surgical Treatment on Survival in Patients With Cervical Spine Metastases

OBJECTIVE: To compare overall survival (OS) in patients with cervical spine metastases between initial radiotherapy followed by surgery and initial surgery followed by radiotherapy. METHODS: The medical records of 36 patients with cervical spine metastases from January 2007 to December 2015 were retrospectively analyzed. These patients were divided into 2 groups. Group 1 included patients who underwent initial radiotherapy followed by surgery, while group 2 included patients who underwent initial surgery followed by radiotherapy. Clinical outcomes, OS, OS after cervical spine metastasis, and OS after surgery were analyzed in both groups. We evaluated whether primary tumor type, initial treatment modality, the modified Tomita score, Eastern Cooperative Oncology Group performance status, Karnofsky performance status, Japanese Orthopedic Association (JOA) score, Nurick grade, Frankel classification, and preoperative symptoms were associated with OS after cervical spine metastasis. RESULTS: Both groups exhibited improvement in the postoperative visual analogue scale, but only group 2 showed a significant improvement in postoperative JOA score (p=0.03). OS did not differ significantly between groups. However, OS after cervical spine metastasis was only 7.0 months (95% confidence interval [CI], 4.8–9.3) in group 1 versus 15.8 months (95% CI, 8.8–24.0) in group 2, which represented a significant difference (p<0.05). Factors related to OS after cervical spine metastasis were primary tumor type, initial treatment modality, and preoperative symptoms (p<0.05). Patients who presented with only preoperative pain had approximately 3 fold longer OS after cervical spine metastasis than patients with preoperative motor weakness, even in group 2 (p<0.05). CONCLUSION: Surgical treatment prior to the onset of motor weakness or radiotherapy may be a good decision in case of cervical spine metastasis.