Page 29 - Predicting survival in patients with spinal bone metastasesL
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                                The rate of positive association for the presence of visceral metastases was 73%, meaning the level of evidence was only just inconclusive. A recent study that stratified the risk factor analysis based on the primary tumor classification found that the effect of visceral metastases on survival changed between different tumor categories4. The survival of patients with a fast growing, aggressive tumor was not affected by visceral metastases, whereas patients with a slow growing tumor did have a significantly shorter survival when visceral metastases were present. The included low risk of bias studies that found a positive association had, on average, 10% more breast cancer patients in their population than studies that did not find an association. This difference in composition of the population might explain the different findings in these studies. The prognostic factor neurologic deficit consisted of two variables; ambulatory status and the Frankel classification. Because of the interaction with the performance status of a patient, this variable can be difficult to obtain, especially retrospectively. Even though it is an important variable to consider when deciding on type of treatment, it is unclear whether this variable plays a role in estimating survival.
In conclusion, prognostication for patients with SBM should be based on an accurate primary tumor classification, combined with a performance score. The added benefit of including the ASA classification should be studied further, as should the influence of visceral metastases and the presence of neurologic deficit.
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SYSTEMATIC REVIEW
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