Prognostic Value of Preclinical Markers after Radiotherapy of Metastatic Spinal Cord Compression-An Additional Analysis of Patients from Two Prospective Trials

Dirk Rades; Jon Cacicedo; Darejan Lomidze; Ahmed Al-Salool; Barbara Segedin; Blaz Groselj; Steven E Schild

doi:10.3390/cancers14102547

Prognostic Value of Preclinical Markers after Radiotherapy of Metastatic Spinal Cord Compression-An Additional Analysis of Patients from Two Prospective Trials

Cancers (Basel). 2022 May 22;14(10):2547. doi: 10.3390/cancers14102547.

Authors

Dirk Rades¹, Jon Cacicedo², Darejan Lomidze³, Ahmed Al-Salool¹, Barbara Segedin⁴, Blaz Groselj⁴, Steven E Schild⁵

Affiliations

¹ Department of Radiation Oncology, University of Lubeck, 23562 Lubeck, Germany.
² Department of Radiation Oncology, Cruces University Hospital/Biocruces Health Research Institute, 48903 Barakaldo, Bizkaia, Spain.
³ Radiation Oncology Department, Tbilisi State Medical University and Ingorokva High Medical Technology University Clinic, Tbilisi 0177, Georgia.
⁴ Department of Radiotherapy, Institute of Oncology Ljubljana, University of Ljubljana, 1000 Ljubljana, Slovenia.
⁵ Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ 85259, USA.

Abstract

For optimal personalization of treatment for metastatic spinal cord compression (MSCC), the patient’s survival prognosis should be considered. Estimation of survival can be facilitated by prognostic factors. This study investigated the prognostic value of pre-treatment preclinical markers, namely hemoglobin, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lactate dehydrogenase (LDH), and c-reactive protein (CRP), in 190 patients from two prospective trials who had poor or intermediate survival prognoses and were irradiated for MSCC with motor deficits. In addition, clinical factors including radiation regimen, age, gender, tumor type, interval from tumor diagnosis to MSCC, number of affected vertebrae, visceral metastases, other bone metastases, time developing motor deficits, ambulatory status, sensory function, and sphincter function were evaluated. On univariate analyses, NLR (p = 0.033), LDH (p < 0.001), CRP (p < 0.001), tumor type (p < 0.001), pre-radiotherapy ambulatory status (p < 0.001), and sphincter function (p = 0.011) were significant. In the subsequent Cox regression analysis, LDH (p = 0.007), CRP (p = 0.047), tumor type (p = 0.003), and ambulatory status (p = 0.010) maintained significance. In addition to clinical factors, preclinical markers may help in estimating the survival of patients irradiated for MSCC. Additional prospective trials are warranted.

Keywords: metastatic spinal cord compression; preclinical markers; prognostic factors; prospective trials; radiotherapy; survival.

Grants and funding

This study was performed within the project Changing Cancer Care, which received funding from the European Regional Development Fund through the Interreg Deutschland-Danmark program. The study itself has not received specific external funding.