BACKGROUND Over the last 2 decades, advances in systemic therapy have increased the expected overall survival for patients with cancer. It is unclear whether the same survival benefit has been conferred to patients requiring surgery for metastatic spinal disease. OBJECTIVE To examine trends in postoperative survival over a 20-yr period for patients surgically treated for spinal metastatic disease. METHODS Data were obtained for 1515 patients who underwent surgery for metastatic epidural spinal cord compression or tumor-related mechanical instability. Postoperative overall survival was calculated for all included patients using Kaplan-Meier methodology from date of surgery until death or last follow-up for those who were censored. Trends were analyzed using Cox proportional hazards modeling. RESULTS Patients with renal, breast, lung, and colon cancers experienced a statistically significant improvement in survival over time based on the year of surgery (40%-100% improvement over the study period), whereas the overall survival trend for the entire cohort did not reach statistical significance (P = .12, median survival 0.71 yr, 95% CI 0.63-0.78). Patients presenting with synchronous metastatic disease had better survival compared to those presenting with metachronous disease (median overall survival: 0.94 vs 0.63 yr, respectively; log-rank P-value = .00001). CONCLUSION The postoperative survival among patients with spinal metastases has improved over the past 20 yr, particularly in patients with kidney, breast, lung, and colon tumors metastatic to the spine. The observed survival improvement emphasizes the need for long-term outcome consideration in treatment decisions for patients undergoing surgery for spinal metastatic tumors.

中文翻译：

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脊柱转移瘤手术后的生存趋势：20 年癌症中心经验

背景 在过去的 20 年中，全身治疗的进步提高了癌症患者的预期总生存期。尚不清楚是否已为因转移性脊柱疾病需要手术的患者提供了相同的生存获益。目的 研究接受脊柱转移性疾病手术治疗的患者在 20 年内的术后生存趋势。方法 获得了 1515 名因转移性硬膜外脊髓压迫或肿瘤相关机械不稳定而接受手术的患者的数据。使用 Kaplan-Meier 方法计算所有纳入患者的术后总生存期，从手术日期到死亡或最后一次随访。使用 Cox 比例风险模型分析趋势。结果 肾、乳腺、肺、根据手术年份，结肠癌和结肠癌的生存率随着时间的推移出现了统计学显着改善（研究期间改善了 40%-100%），而整个队列的总体生存趋势没有达到统计学显着性（P = .12 ，中位生存期 0.71 年，95% CI 0.63-0.78）。与异时性疾病患者相比，同步转移性疾病患者的生存率更高（中位总生存期：分别为 0.94 和 0.63 年；对数秩 P 值 = .00001）。结论 脊柱转移瘤患者的术后生存率在过去 20 年有所改善，尤其是肾、乳腺、肺和结肠肿瘤转移到脊柱的患者。