Comparing prognostic factors in patients with spinal metastases: a literature review

For cancer patients with spinal metastases, palliative treatments are directed toward improving the patient's symptoms and quality of life. The expected prognosis of patients plays a large role in guiding treatment decisions, particularly when deciding between surgical management and conservative treatments, such as radiotherapy. This study aims to review the factors that can accurately predict the survival of patients with spinal metastases. The authors conducted a literature search on studies identifying prognostic factors using PubMed (1966–2011), Ovid MEDLINE (1948 to July 2011) and EMBASE (1947–2011) databases. Articles in English were included if they conducted retrospective or prospective analyses on predictors of survival for patients with spinal metastases; articles validating or examining the accuracy of existing scoring systems using prognostic factors were also included. A total of 29 studies were identified. A general consensus of the literature was found with respect to three prognostic factors: the patient's primary cancer site, the extent of the metastases and the general condition or performance score. Further research is recommended to assess the prognostic value of other factors identified by several studies, including age, neurological deficit and previous treatments. For future studies, the authors encourage the development of models capable of inclusion of all patients with spinal metastases.