Patient Characteristics Following Surgery for Spinal Metastases: A Multicenter Retrospective Study

Abstract

Objectives: To summarize the epidemiological characteristics of patients following surgery for spinal metastases retrospectively and make a univariate analysis to identify independent variables that could affect the operation decision making.

Methods: This was a multicenter retrospective review of patients with spinal metastasis who were treated with surgery from 1 January 2007 to 31 July 2019. Basic clinical data were analyzed retrospectively by univariate analysis to identify independent variables that could affect the decision of operation modalities, including gender, age, spinal metastatic site, Frankel score, Karnofsky performance score (KPS), spinal instability neoplastic score (SINS), visual analogue scale (VAS), Tokuhashi score, urinary and fecal incontinence, spinal pathological fracture, primary tumor, extraspinal metastasis, visceral metastasis, and bone lesion (osteolytic, osteoblastic or mixed).

Results: A total of 580 patients including 332 males and 248 females were enrolled in the study with an average age of 58.26 years old (range, 13-86 years old). The most common spinal metastatic level was the thoracic vertebra (190 [32.76%]), followed by the lumbar vertebra (146 [25.17%]), cervical vertebra (47 [8.10%]), and sacral vertebra (35 [6.03%]). Metastases involving more than two sites of the cervical, thoracic, lumbar, and sacral vertebrae arose in 162 (27.93%) patients. For primary tumor, there were 198 (34.14%) cases of lung cancer, 41 (7.07%) cases of kidney cancer, 39 (6.72%) cases of breast cancer, 38 (6.55%) cases of gastrointestinal cancer, 35 (6.03%) cases of lymphoma and myeloma, 25 (4.31%) cases of prostate cancer, 24 (4.14%) cases of liver cancer, 23 (3.97%) cases of mesenchymal tissue sarcoma, 20 (3.45%) cases of thyroid cancer, and 84 (14.48%) cases were tumor with unknown origin. Sixty-three (10.86%) patients received minimally invasive surgery, 460 (79.31%) patients received palliative surgery, and the remaining 57 (9.83%) received tumor resection. According to the univariate analysis, the KPS score, SINS score, VAS score, Tokuhashi score, urinary and fecal incontinence, spinal pathological fracture, and bone lesion (osteolytic, osteoblastic or mixed) were independent and favorable factors affecting the surgery modalities.

Conclusions: Surgical treatment for spinal metastases was mainly to relieve pain, rebuild spinal stability, improve nerve function, control local tumors, and improve the quality of life of patients. For middle-aged and elderly patients with good general conditions, severe pain, spinal pathological fracture, spine instability and without urinary and fecal incontinence, early surgical treatment should be actively carried out.

Keywords: Epidemiological study characteristics; Spinal metastases; Surgical treatment; Univariate analysis.

Figure 1

Spinal metastatic level among the 580 patients. The most common spinal metastatic site was the thoracic vertebra (190 [32.76%]), followed by the lumbar vertebra (146 [25.17%]), cervical vertebra (47 [8.10%]), sacral vertebra (35 [6.03%]) and trans‐segmental metastasis (162 [27.93%]). Only one single segment metastasis was presented in 247 (42.59%) and two or more segment metastasis was in 333 (57.41%).

Figure 2

Distribution of the primary tumors in 580 patients with spinal metastasis treated with surgery. Lung cancer was the most one in 198(34.14%) cases. Kidney cancer, breast cancer, gastrointestinal cancer, lymphoma, and myeloma did not show significant difference. Prostate cancer, liver cancer and mesenchymal tissue sarcoma were nearly at the same. 84 (14.48%) cases were with unknown origin of tumor but with clear pathological examinations.

Figure 3

Distribution of Tokuhashi score, SINS score, VAS score, Frankel score and KPS score in 580 patients treated with surgery. Tokuhashi score more than nine was shown in 488 (84.14%) patients; 485 (83.62%) patients presented spinal instability with SINS score more than 7; 471 (81.21%) patients presented pain with VAS score more four. As for neurological impairment, 90 (15.52%) patients presented paralysis.