J Med Assoc Thai 2023; 106 (4):S108-13

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Malignant Spinal Cord Compression: Clinical Presentation, Treatment Outcome and Prognostic Factors
Kumpamool P Mail, Sookprasert A , Jindaprasirt J , Wirasorn K

Background: Malignant spinal cord compression (MSCC) is an emergency condition in oncology, which immediately needs appropriate treatment. Additionally, MSCC has high morbidity. The aim of the present study is to evaluate clinical presentation, treatment outcome and to determine prognostic factors in MSCC patients. 
Materials and Methods: A retrospective study was conducted and enrolled 71 adult patients with newly diagnosed of MSCC by using Magnetic Resonance Imaging (MRI) or myelogram in Srinagarind University Hospital, Khon Kean, Thailand from January 1st, 2000 to December 31st, 2010. Clinical and survival data were evaluated by uni- and stepwise multivariate analysis.
Results: 71 patients with MSCC were enrolled; 46 male (65%) and 25 female (35%), with an average age of 51 years old. The highest incidence age of MSCC was 41 to 60 years old. The most common primary malignant site was unknown primary origin (39.5%) followed by lung cancer (11.3%), lymphoma (7.0%), prostate cancer (5.6%), cholangiocarcinoma (5.6%) and hepatocellular carcinoma (5.6%). The most common presenting symptom was weakness (88.7%) and grade 0 of motor function was commonly found compared to the others. The modalities of treatment were surgery, radiation, chemotherapy, and steroid therapy. The most common treatment was radiation plus steroid. Only 14 patients (20%) received chemotherapy. These patients were diagnosed with hematologic malignancy (42.8%) particularly lymphoma and acute leukemia. The overall survival time of patients was about 6.8 months (95% confidence interval, CI: 5.8 to 7.7). Patients with age less than 40 years old, receiving either steroid treatment or chemotherapy tended to have longer survival time. Only chemotherapy treatment was a significantly good prognostic factor (Hazard ratio was 0.84; 95% CI: 0.73 to 0.96).

Conclusion: MSCC is the important disease that causes disability, decreased quality of life and high mortality. Early diagnosis and treatment might improve survival time in patients particularly who receiving chemotherapy and having chemo-sensitive tumor with good performance.

Keywords: Malignant spinal cord compression, MSCC, Clinical presentations, Treatment outcome, Prognostic factor

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