Surgical Efficacy and Prognosis of 54 Cases of Spinal Metastases from Breast Cancer.

Objective: To analyze the efficacy and complications of spinal metastasis surgery for breast cancer; to understand the survival and the influencing factors; and to verify the predictive ability of the currently used spinal metastasis cancer survival prediction scoring system on 1 year postoperative survival.

Methods: A retrospective study was conducted of 54 patients with spinal metastases from breast cancer who underwent open surgery after multidisciplinary consultation in our hospital from January 2017 to October 2020. Patient demographic-related variables, breast cancer-related variables, spinal disorder-related variables, and treatment-related variables were collected. Survival curves were plotted using the Kaplan-Meier method, 1-way tests were performed using the log-rank method for factors that might affect prognosis, and candidate variables were included in the Cox model for multifactor analysis. The Tomita score, modified Tokuhashi score, modified Bauer score, and modified Katagiri score were examined by plotting the subject operating characteristic curve and calculating the area under the curve. The area under the curve was used to test the predictive ability of the SORG (Skeletal Oncology Research Group) original version, SORG line graph version, and SORG Web version for 1-year postoperative survival in patients with spinal metastases from breast cancer.

Results: The average age was 51.3 ± 8.6 years in 54 patients. Twenty-one patients underwent vertebral body debulking surgery, 32 patients underwent palliative canal decompression, and 1 patient underwent vertebral en bloc resection, with an operative time of 229.3 ± 87.6 minutes and intraoperative bleeding of 1018.1 ± 931.1 mL. Postoperatively, the patient experienced significant pain relief and gradual recovery from nerve injury. Major surgical complications included cerebrospinal fluid leakage, secondary spinal cord injury, spinal tumor progression, and broken fixation. The mean survival was 32.2 months, including a 6-month survival of 90.7%, a 1-year survival of 77.8%, and a 2-year survival of 60.3%. Univariate analysis showed that preoperation with neurologic deficits, hormone-insensitive type, with brain metastases were potential risk factors for poor prognosis. Multifactorial analysis showed that hormone-insensitive type and concomitant brain metastasis were independent risk factors associated with poor prognosis. The SORG Web version had good ability to predict 1-year postoperative survival in patients with spinal metastases from breast cancer.

Conclusions: Spinal metastasis from breast cancer has good surgical efficacy, low postoperative recurrence rate, and relatively long survival after surgery. Patients with hormone-insensitive type, with brain metastasis, have a poor prognosis, and SORG Web version can predict patients' 1-year survival more accurately.