Surgery and Prognostic Factors of Patients with Epidural Spinal Cord Compression Caused by Hepatocellular Carcinoma Metastases: Retrospective Study of 36 Patients in a Single Center

Study Design: A retrospective study of 36 patients with metastatic hepatocellular carcinoma (HCC) of the mobile spine was performed by survival analysis.

Objective: To discuss the factors that may affect outcomes of patients with HCC spinal metastases.

Summary Of Background Data: HCC is a rare tumor in Western countries. However, HCC is common in Far East (Taiwan, Korea, mainland China), where the hepatitis B virus is epidemic. As the mean survival time of patients with HCC has largely increased in recent years, it is now more common to encounter a patient with epidural spinal cord compression caused by HCC spinal metastases in clinic.

Methods: The univariate and multivariate analyses of various clinical factors were performed to identify independent variables that could predict prognosis. The survival rate was estimated by the Kaplan-Meier method, and differences were analyzed by the log-rank test. Factors with P values of 0.1 or less were subjected to multivariate analysis for survival rate by multivariate Cox proportional hazards analysis.

Results: A total of 36 patients with metastatic HCC of the mobile spine were included in the study. Age (≤45 yr/>45 yr), duration of preoperative symptoms (<6 mo/≥6 mo), preoperative Frankel score (A-C/D-E), Tomita score (5-7/8-10), and bisphosphonate treatment were suggested as the potential prognostic factors through univariate analysis. However, as they were submitted to the multivariate Cox regression model, only Tomita score was found as an independent prognostic factor.

Conclusion: Tomita score no more than 7 is a favorable prognostic factor for HCC metastases in the mobile spine.

Level Of Evidence: 4.