Spinal metastasis: narrative reviews of the current evidence and treatment modalities

Jaipanya, Pilan; Chanplakorn, Pongsthorn

doi:10.1177/03000605221091665

Cited by 24 publications

(8 citation statements)

References 98 publications

(255 reference statements)

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“…The humerus, femur and tibia are the most common targets of long bone metastasis, particularly from primary tumors originating from the breast, thyroid, kidney, lung and prostate [ 4 ]. Spinal metastases affect up to 70% of patients with cancer with a severe risk of para- or tetraplegia development due to metastatic spinal cord compression [ 5 ]. Orthopedic treatment of metastatic bone disease aims to alleviate pain and increase mobility and functional independence.…”

Section: Introductionmentioning

confidence: 99%

Age, sex, primary tumor type and site are associated with mortality after pathological fractures: an observational study of 1453 patients from the Swedish Fracture Register

et al. 2023

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Background Pathological fractures are challenging in orthopedic surgery and oncology, with implications for the patient’s quality of life, mobility and mortality. The efficacy of oncological treatment on life expectancy for cancer patients has improved, but the metastatic pattern for bone metastases and survival is diverse for different tumor types. This study aimed to evaluate survival in relation to age, sex, primary tumor and site of the pathological fractures. Methods All pathological fractures due to cancer between 1 September 2014 and 31 December 2021 were included in this observational study from the Swedish Fracture Register (SFR). Data on age, sex, tumor type, fracture site and mortality were collected. Results A total of 1453 patients with pathological fractures were included (48% women, median age 73, range 18–100 years). Unknown primary tumors were the most common primary site (n = 308). The lower extremities were the most common site of pathological fractures. Lung cancer had the shortest median survival of 78 days (range 54–102), and multiple myeloma had the longest median survival of 432 days (range 232–629). The site at the lower extremity had the shortest (187 days, range 162–212), and the spine had the longest survival (386 days, range 211–561). Age, sex, primary type and site of the pathological fractures were all associated with mortality. Interpretation Age, sex, primary tumor type and site of pathological fractures were associated with survival. Survival time is short and correlated with primary tumor type, with lung cancer as the strongest negative predictor of survival.

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Section: Introductionmentioning

confidence: 99%

Age, sex, primary tumor type and site are associated with mortality after pathological fractures: an observational study of 1453 patients from the Swedish Fracture Register

et al. 2023

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“…The humerus, femur and tibia are the most common targets of long bone metastasis, particularly from primary tumors originating from the breast, thyroid, kidney, lung and prostate [4]. Spinal metastases affect up to 70% of patients with cancer with a severe risk of para-or tetraplegia development due to metastatic spinal cord compression [5]. Orthopedic treatment of metastatic bone disease aims to alleviate pain and increase mobility and functional independence in the setting of metastatic disease.…”

Section: Introductionmentioning

confidence: 99%

Age, sex, primary tumor type and site are associated with mortality after pathological fractures: An observational study of 1,453 patients from the Swedish Fracture Register

Wänman

Kjartansdóttir

Wolf

et al. 2023

Preprint

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Background Pathological fractures are challenging in orthopedic surgery and oncology, with implications for the patient’s quality of life, mobility and mortality. The efficacy of oncological treatment on life expectancy for cancer patients has improved, but the metastatic pattern for bone metastases and survival is diverse for different tumor types. This study aimed to evaluate survival in relation to age, sex, primary tumor and site of the pathological fractures. Methods All pathological fractures due to cancer between 1 September 2014 and 31 December 2021 were included in this observational study from the Swedish Fracture Register (SFR). Data on age, sex, tumor type, fracture site and mortality were collected. Results 1,453 patients with pathological fractures were included (48% women, median age 73, range 18-100 years). Unknown primary tumors were the most common primary site (n=308). The lower extremities were the most common site of pathological fractures. Lung cancer had the shortest median survival of 78 days (range 54-102) and multiple myeloma had the longest median survival of 432 days (range 232-629). The site at the lower extremity had the shortest (187 days, range 162-212) and the spine had the longest survival (386 days, range 211-561). Age, sex, primary type and site of the pathological fractures were all associated with mortality. Interpretation Age, sex, primary tumor type and site of pathological fractures significantly impact survival. Survival time is short and correlated to primary tumor type, with lung cancer as the strongest negative predictor of survival.

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“…Spine metastases are a severe consequence of cancer patients, and the incidence of spine metastases has significantly increased due to growing cancer patients and prolonged life expectancy among those patients [2]. This disease is featured by intractable severe back pain, neurological sequelae, and even incontinence and disability, all of which could have a significant impact on the quality of life among patients with a limited life expectancy [3].…”

Section: Introductionmentioning

confidence: 99%

“…However, even though studies have pointed out that the therapeutic options, like radiotherapies and spinal procedures, could improve the quality of life for patients with spine metastases [2], it was difficult to predict the quality of life in advance, and inappropriate patient's selection and interventions could even cause harms to patients and deteriorate their quality of remaining life. Fortunately, a number of factors including age [4], gender [4], sarcopenia [5], financial difficulty scores [6], Eastern Cooperative Oncology Group (ECOG) scores, the percentage weight loss, and modified Glasgow Prognostic score [7], have been found to be associated with quality of life.…”

Section: Introductionmentioning

confidence: 99%

“…Li et al BMC Cancer (2022) 22:1205 confirmed by tissue biopsy and radiography such as magnetic resonance imaging (MRI) and/or computer tomography (CT) were included in the study. Patients were excluded, if they (1) were younger than 18 years of age, (2) were reluctant to participant in the study, (3) had been diagnosed with psychiatric disorders; (4) had metastases to the extremities or rib rather than the spine; (5) had an expected survival of less than 3 months according to Tomita [10], Takahashi [11], and Lei and Liu [12] scores [13]; (6) had a ECOG score of 5.…”

Section: Introductionmentioning

confidence: 99%

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A novel nomogram to stratify quality of life among advanced cancer patients with spinal metastatic disease after examining demographics, dietary habits, therapeutic interventions, and mental health status

Long

Wang

et al. 2022

BMC Cancer

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Background It would be very helpful to stratify patients and direct patient selection if risk factors for quality of life were identified in a particular population. Nonetheless, it is still challenging to forecast the health-related quality of life among individuals with spinal metastases. The goal of this study was to stratify patient’s populations for whom the assessment of quality of life should be encouraged by developing and validating a nomogram to predict the quality of life among advanced cancer patients with spine metastases. Methods This study prospectively analyzed 208 advanced cancer patients with spine metastases, and collected their general characteristics, food preferences, addictions, comorbidities, therapeutic strategies, and mental health status. The functional assessment of cancer therapy-general (FACT-G) and hospital anxiety and depression scale (HADS) were used to assess quality of life and mental health, respectively. The complete cohort of patients was randomly divided into two groups: a training set and a validation set. Patients from the training set were conducted to train and develop a nomogram, while patients in the validation set were performed to internally validate the nomogram. The nomogram contained significant variables discovered using the least absolute shrinkage and selection operator (LASSO) approach in conjunction with 10-fold cross-validation. The nomogram’s predictive ability was assessed utilizing discrimination, calibration, and clinical usefulness. Internal validation was also completed using the bootstrap method after applying 500 iterations of procedures. A web calculator was also developed to promote clinical practice. Results Advance cancer patients with spinal metastases had an extremely low quality of life, as indicated by the average FACT-G score of just 60.32 ± 20.41. According to the LASSO and 10-fold cross-validation, Eastern Cooperative Oncology Group (ECOG) score, having an uncompleted life goal, preference for eating vegetables, chemotherapy, anxiety status, and depression status were selected as nomogram predictors. In the training set, the area under the receiver operating characteristic curve (AUROC) was 0.90 (95% CI: 0.84–0.96), while in the validation set, it was 0.85 (95% CI: 0.78–0.93). They were 0.50 (95% CI: 0.41–0.58) and 0.44 (95% CI: 0.33–0.56), respectively, for the discrimination slopes. The nomogram had favorable capacity to calibrate and was clinically useful, according to the calibration curve and decision curve analysis. When compared to patients in the low-risk group, patients in the high-risk group were above four times more likely to experience a poor quality of life (82.18% vs. 21.50%, P < 0.001). In comparison to patients in the low-risk group, patients in the high-risk group also exhibited significant higher levels of anxiety and depression. The webpage for the web calculator was https://starshiny.shinyapps.io/DynNomapp-lys/. Conclusions This study suggests a nomogram that can be applied as a practical clinical tool to forecast and categorize the quality of life among patients with spine metastases. Additionally, patients with poor quality of life experience more severe anxiety and depression. Effective interventions should be carried out as soon as possible, especially for patients in the high-risk group, to improve their quality of life and mental health condition.

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Spinal metastasis: narrative reviews of the current evidence and treatment modalities

Cited by 24 publications

References 98 publications

Age, sex, primary tumor type and site are associated with mortality after pathological fractures: an observational study of 1453 patients from the Swedish Fracture Register

Age, sex, primary tumor type and site are associated with mortality after pathological fractures: an observational study of 1453 patients from the Swedish Fracture Register

Age, sex, primary tumor type and site are associated with mortality after pathological fractures: An observational study of 1,453 patients from the Swedish Fracture Register

A novel nomogram to stratify quality of life among advanced cancer patients with spinal metastatic disease after examining demographics, dietary habits, therapeutic interventions, and mental health status

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