Prognostic Factors for Bone Survival and Functional Outcomes in Patients With Breast Cancer Spine Metastases

Abstract

According to the Global Cancer Statistics 2020 report, breast cancer is the most commonly diagnosed cancer worldwide. Patients with mammary cancer live longer due to the continuous optimization of chemotherapy, targeted drugs, and hormone therapy, which will inevitably lead to an increase in the prevalence of metastatic bone tumors. Bone metastasis affects approximately 8% of patients with mammary cancer, with the spine being the most common site. Metastatic neoplasms can invade the centrum and its attachments, leading to local pain, spinal instability, vertebral pathological fractures, spinal cord compression, impaired neurological function, and paralysis, ultimately reducing the quality of life. Multidisciplinary and personalized management using analgesic drugs, endocrine therapy, corticosteroid therapy, chemotherapy, bisphosphonates, immunotherapy, targeted drugs, radiotherapy, and surgery has been advocated for the treatment of spinal metastases. Multiple paradigms and systems have been proposed to determine suitable treatments. In the early stages, the occurrence of metastasis indicates a terminal stage of the tumor process in patients with malignant tumors, implying that their lifespan is limited. As a result, the choice of treatment is heavily influenced by longevity. However, with the development of treatment methods, the lifespan of patients with tumors has considerably increased in recent years. This leads to the choice of patient’s treatment, which depends not only on the patient’s survival, but also on the radiotherapy or postoperative functional outcomes. Nevertheless, they fall short of determining the variables that affect survival and functional outcomes in histology-specific subgroups of breast cancer. To accurately predict the bone survival and functional outcomes of patients with breast cancer spine metastases a review of prognostic factors was performed.

Survival and Neurological Outcomes Following Corpectomy for Spinal Metastatic Disease: A Single Institutional Experience

“…Given the continued advances in cancer survivorship, this treatment paradigm may need to be revisited. While preserving and restoring neurological function remains a primary goal of spinal oncology surgery, maximal tumor debulking with excision of part or all of the vertebral body (corpectomy) for improved local disease control, restoration of spinal alignment and spinal stabilization with the goal of long-term pain relief, functional independence, and improved diseasefree survival may need to be taken into account in a select cohort of patients [9,18,19]. Corpectomy of one or more levels may prove indicated and necessary where other less invasive treatment modalities fail leading to gradually worsening clinical outcome (Figure 2).…”

“…While the minimal footprint of separation surgery allows patients to resume systemic therapy earlier, the continued improvement in cancer survivorship means such an approach could predispose a select cohort of patients to redo surgeries and/or recurrent radiation treatments (due to local tumor recurrence). Furthermore, it can also result in significant long-term disability and loss of functional independence from chronic pain symptoms as it doesn't restore spinal alignment and does not achieve circumferential stabilization, resulting in worsening kyphotic deformity and hardware failure (Figure 1) [9,18,19]. In oligometastatic spinal disease patients with good functional status and favorable long-term prognosis, corpectomy with fusion can allow for maximal tumor debulking for improved local disease control, restoration of spinal alignment, and spinal stabilization for long-term pain relief, functional independence, and improved disease-free survival (Figure 7).…”

Lactate secreted via MCT4 from bone‑colonizing breast cancer excites sensory neurons via GPR81

“…Breast cancer (BC) frequently metastasizes to bone ( 1 ), inducing bone pain (BP) ( 2 ). BC-BP disrupts the quality of life and limits physical and mental activity of patients with BC, resulting in poor outcomes ( 3 ). Proper and satisfactory management of BP is therefore an important challenge for the improvement of quality of life and survival of these patients.…”

Breast cancer cells promote osteoclast differentiation in an MRTF-dependent paracrine manner

“…The vast majority of breast cancer-related deaths are due to the metastatic spread of tumor cells to distant organs. Bone is a frequent site of breast cancer metastasis with the median survival of patients after tumor cells have metastasized to the bone being 2-3 years (1)(2)(3)(4). Bone metastasis falls into three different categories, namely osteolytic (involves bone resorption), osteoblastic (involves deposition of new bone), and mixed (involves both formation and resorption of bone) with the vast majority of breast cancer-associated metastasis being osteolytic in nature (>70%) (5).…”