Epidemiological study of spine metastases: a 481 cases report

English Keywords:Spinal metastasis tumor  Retrospective study  Multicenter study  Epidemiological analysis

English Abstract:

  【Abstract】 Objectives: To explore the clinical and epidemiological characteristics of patients with spinal metastases. Methods: From January 2007 to December 2016, 481 patients with spinal metastases in three centers were administered. The demographic data, type of primary tumor, location of metastases, clinical feature and therapeutic modality of all the patients were collected and analyzed retrospectively. Inclusion criteria was as following: patients diagnosed with spinal metastases by clinical, iconography and pathological evidences, with complete medical documents available. While patients without pathological evidence, diagnosis of primary spinal tumor not being eliminated, tuberculosis, degenerative diseases, and patients with incomplete medical documents were all excluded. Each relapsing patient was regarded as a single case. Results: All the 481 patients suffered from spinal metastasis met inclusion criteria in this study, including 287 males(59.7%) and 194 females(40.3%). The mean age of all the patients was 59.2±11.1 years old(range, 18-86 years old), and the high peak age of those patients was from 50 to 69 years. The mean age of female group was 58.5±10.5 years old which was slightly younger than male group(59.6±11.5 years), no significant difference was observed(t=0.277, P＞0.05). There were 181 cases of lung cancer, 40 cases of renal cancer, 29 cases of breast cancer, 25 cases of liver cancer, 23 cases of gastrointestinal cancer, 20 cases of prostate cancer; the numbers of thyroid, esophaseal and other cancers were all less than 20, which accounted to 70 in total; 93 cases were with unknown origin of tumor. The most common spinal metastatic site was the thoracic spine(135 cases), followed by the lumbar spine(130 cases), sacral spine(42 cases), cervical spine(37 cases), and salatory metastases(metastases involved more than two sites of the cervical, thoracic, lumbar and sarcum vertebrae) arose in 137 patients. 281 patients were admitted to hospital with complaint of spinal cord compression and pain, while 128 patients with only pain and 33 patients with only spinal cord compression, 39 patients were found spinal metastasis with no symptom in regular checkups, and 75 patients with known primary cancer. The patients were divided into surgery(314 cases) and non-surgery(167 cases) group. Concerning therapeutic modalities, patients in surgery group included 266 patients with open approach, and 48 patients with percutaneous vertebroplasty(PVP) or percutaneous balloon kyphoplasty(PKP), while 167 patients in non-surgery group were treated by bisphosphonates, radionuclide, radiotherapy, and other symptomatic therapies. Conclusions: There is a higher incidence for male to suffer from spinal metastases than female, with a peak age of 50-69 years. Symptoms caused by metastases are the main reasons for visit, and few of them have specific primary tumor history. Primary lesions are largely originated from epithelium and gland of viscera, especially common in lung. But metastases from mesenchymal tumors are relatively rare. Lumbar and thoracic spine are more common involved vertebrae. Palliative therapies are adopted for majority of the patients to relieve clinical symptoms.