Epidemiology of spinal metastases, metastatic epidural spinal cord compression and pathologic vertebral compression fractures in patients with solid tumors: A systematic review

Ruben Van den Brande; Erwin Mj Cornips; Marc Peeters; Piet Ost; Charlotte Billiet; Erik Van de Kelft

doi:10.1016/j.jbo.2022.100446

Epidemiology of spinal metastases, metastatic epidural spinal cord compression and pathologic vertebral compression fractures in patients with solid tumors: A systematic review

J Bone Oncol. 2022 Jul 9:35:100446. doi: 10.1016/j.jbo.2022.100446. eCollection 2022 Aug.

Authors

Ruben Van den Brande^{1

2}, Erwin Mj Cornips², Marc Peeters^{1

3}, Piet Ost^{4

5}, Charlotte Billiet^{4

5}, Erik Van de Kelft^{1

6}

Affiliations

¹ University of Antwerp, Belgium.
² Department of Neurosurgery, Ziekenhuis Oost Limburg Genk, Belgium.
³ Department of Oncology, Antwerp University Hospital, Belgium.
⁴ Iridium Network, Antwerp, Belgium.
⁵ Department of Radiotherapy, GZA Hospital, Antwerp, Belgium.
⁶ Department of Neurosurgery, Vitaz Sint-Niklaas, Belgium.

Abstract

Introduction: Spinal metastases (SM) are a frequent complication of cancer and may lead to pathologic vertebral compression fractures (pVCF) and/or metastatic epidural spinal cord compression (MESCC). Based on autopsy studies, it is estimated that about one third of all cancer patients will develop SM. These data may not provide a correct estimation of the incidence in clinical practice.

Objective: This systematic review (SR) aims to provide a more accurate estimation of the incidence of SM, MESCC and pVCF in a clinical setting.

Methods: We performed a SR of papers regarding epidemiology of SM, pVCF, and MESCC in patients with solid tumors conform PRISMA guidelines. A search was conducted in the PubMed and Web of Science database using the terms epidemiology, prevalence, incidence, global burden of disease, cost of disease, spinal metastas*, metastatic epidural spinal cord compression, pathologic fracture, vertebral compression fracture, vertebral metastas* and spinal neoplasms. Papers published between 1975 and august 2021 were included. Quality was evaluated by the STROBE criteria.

Results: While 56 studies were included, none of them reports the actual definition used for MESCC and pVCF, inevitably introducing heterogenity. The overall cumulative incidence of SM and MESCC is 15.67% and 2.84% respectively in patients with a solid tumor. We calculated a mean cumulative incidence in patients with SM of 9.56% (95% CI 5.70%-13.42%) for MESCC and 12.63% (95% CI 7.00%-18.25%) for pVCF. Studies show an important delay between onset of symptoms and diagnosis.

Conclusions: While the overall cumulative incidence for clinically diagnosed SM in patients with a solid tumor is 15.67%, autopsy studies reveal that SM are present in 30% by the time they die, suggesting underdiagnosing of SM. Approximately 1 out of 10 patients with SM will develop MESCC and another 12.6% will develop a pVCF. Understanding these epidemiologic data, should increase awareness for first symptoms, allowing early diagnosis and subsequent treatment, thus improving overall outcome.

Keywords: CA, carcinoma; CI, confidence interval; Epidemiology; HCC, hepatocellular carcinoma; LOL, length of life; MESCC, metastastic epidural spinal cord compression; MRI, magnetic resonance imaging; Metastatic epidural spinal cord compression; OR, odds ratio; Oncology; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; Pathologic vertebral compression fracture; QOL, quality of life; RCT, randomized controlled trial; SINS, spinal instability neoplastic score; SM, spinal metastases; SR, systematic review; SRE, skeletal related event; ST, solid tumor; STROBE, Strengthening the reporting of observational studies in epidemiology; Spinal metastases; WHO, World Health Organization; pVCF, pathologic vertebral compression fractures; rMESCC, subclinical radiographic MESCC.

Publication types

Review