Epidemiological characters of patients with spinal metastases: a multi-center case study / 中华骨科杂志

ABSTRACT

Objective:To observe the epidemiological characteristics of spinal metastases by retrospectively analyzing the medical records of multicenter spinal metastases in China.Methods:Patients with spinal metastases were identified from several clinical centers between January 2007 and July 2019. A total of 1 976 patients were included in this study, including 1 129 males (57.14%) and 847 females (42.86%). The mean age was 58.6±11.6 years (range 13-92 years). The demographic characteristics, primary tumor types, spinal involvement of each patient were summarized and their clinical indicators were obtained by consulting medical records, including Frankel grade, visual analog scale (VAS), metastatic spinal cord compression (MSCC), Tokuhashi revised score, the spinal instability neoplastic score (SINS), Karnofsky performance status (KPS), and history of malignant tumors. Finally, the intervention influencing factors of patients undergoing surgical treatment were statistically analyzed.Results:The ratio of male to female in 1 976 spinal metastases was 1.33∶1. The median age was 59.0, and most patients (63.71%) were in the ages range of 50-69. The average age of female was younger than male, and the difference was statistically significant. The proportion of male patients over 60 years old was higher than females, and the difference was statistically significant. The most common primary tumor was lung cancer (n=730, 36.94%), followed by unknown origin (n=326, 16.50%), breast cancer (n=159, 8.05%), kidney cancer (n=120, 6.07%), gastrointestinal cancer (n=109, 5.52%), etc. The most common primary tumor was lung cancer in both males and females, followed by unknown origin in males and breast cancer in females. In the past 10 years, the proportion of unknown origin has decreased, and the proportion of breast cancer has increased. According to the Tomita score, 1 284 patients (64.98%) were rapid growth tumors, 211 patients (10.68%) were moderate growth tumors, and 481 patients (24.34%) were slow growth tumors. There were 730 patients (57.14%) in the subgroup of the number<3, the most level of which was lumbar vertebrae, with 368 patients (32.60%). The remaining 847 patients (42.86%) were included in the subgroup of the number≥3, the most level of which was multiple-level of spine, with 617 patients (72.85%). Among the 1 976 patients, spinal cord injury occurred in 50.76% of patients, in which 77.18% of patients developed moderate and above pain, 14.02% of patients appeared metastatic spinal cord compression, and only 28.95% of patients had a clear history of primary tumor. In terms of treatment, 34.92% of patients underwent surgery, 5.97% underwent radiotherapy on spinal metastases, 6.02% underwent chemotherapy, and 1.77% underwent targeted therapy. Preoperative Frankel grade, SINS, and Tokuhashi revised score were important factors affecting the surgical treatment of patients.Conclusion:This study describes the epidemiological characteristics of multicenter spinal metastases in detail, which could assist orthopedic surgeons to understand the clinical characteristics of spinal metastases and was of great significance on guiding the clinical diagnoses and scientific researches.