Positive and negative prognostic variables for patients undergoing spine surgery for metastatic breast disease |
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Authors: | Daniel M Sciubba Ziya L Gokaslan Ian Suk Dima Suki Marcos V C Maldaun Ian E McCutcheon Remi Nader Richard Theriault Laurence D Rhines Joseph A Shehadi |
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Institution: | (1) Department of Neurosurgery, Johns Hopkins University, 600 North Wolfe Street, Meyers Building 8-161, Baltimore, MD 21287, USA;(2) Department of Neurosurgery, M.D. Anderson Cancer Center, Houston, TX, USA;(3) Department of Breast Medical Oncology, M.D. Anderson Cancer Center, Houston, TX, USA |
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Abstract: | The histology of the primary tumor in metastatic spine disease plays an important role in its treatment and prognosis. However,
there is paucity in the literature of histology-specific analysis of spinal metastases. In this study, prognostic variables
were reviewed for patients who underwent surgery for breast metastases to the spinal column. Respective chart review was done
to first identify all patients with breast cancer over an 8-year period at a major cancer center and then to select all those
with symptomatic metastatic disease to the spine who underwent spinal surgery. Univariate and multivariate analyses were used
to assess several prognostic variables. Presence of visceral metastases, multiplicity of bony lesions, presence of estrogen
receptors (ER), and segment of spine (cervical, thoracic, lumbar, sacral) in which metastases arose were compared with patient
survival. Eighty-seven patients underwent 125 spinal surgeries. Those with estrogen receptor (ER) positivity had a longer
median survival after surgery compared to those with estrogen receptor negativity. Patients with cervical location of metastasis
had a shorter median survival compared with those having metastases in other areas of the spine. The presence of visceral
metastases or a multiplicity of bony lesions did not have prognostic value. In patients with spinal metastases from breast
cancer, aggressive surgical management may be an option for providing significant pain relief and preservation/improvement
of neurological function. Interestingly, in patients undergoing such surgery, cervical location of metastasis is a negative
prognostic variable, and ER-positivity is associated with better survival, while presence of visceral or multiple bony lesions
does not significantly alter survival. |
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Keywords: | Breast cancer Estrogen receptor Metastases Prognosis Spine surgery |
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