A tool to estimate survival of elderly patients presenting with metastatic epidural spinal cord compression (MESCC) from cancer of unknown primary

Aim: Cancers of unknown primary (CUP) account for about 10% in elderly patients with MESCC. Immediate treatment is indicated. Personalizing treatment for MESCC requires for clear understanding of the patients' survival prognosis. In this case, a tool for estimating survival would be valuable. Patients and Methods: In 104 elderly CUP patients, nine factors were investigated: age, gender, performance score, number of affected vertebrae, ability to walk at presentation for radiotherapy, additional bone metastases, visceral metastases, time developing motor weakness, radiotherapy program. Results: In multivariate analysis, the ability to walk (p=0.011) and visceral metastases (p<0.001) were associated with survival. The following scores were assigned: unable to walk=0, able to walk=1, visceral metastases=0, no visceral metastases=1. Three groups were formed (0, 1 and 2 points) with 6-month survival rates of 7%, 18% and 73% (p<0.001). Conclusion: This specific tool assists the physician to estimate survival and select for the most suitable radiotherapy program in elderly CUP patients with MESCC.