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Review
. 2016 Aug;6(5):482-96.
doi: 10.1055/s-0035-1564807. Epub 2015 Oct 21.

A Systematic Review of Clinical Outcomes and Prognostic Factors for Patients Undergoing Surgery for Spinal Metastases Secondary to Breast Cancer

Daniel M Sciubba  1 , C Rory Goodwin  1 , Alp Yurter  1 , Derek Ju  1 , Ziya L Gokaslan  1 , Charles Fisher  2 , Laurence D Rhines  3 , Michael G Fehlings  4 , Daryl R Fourney  5 , Ehud Mendel  6 , Ilya Laufer  7 , Chetan Bettegowda  1 , Shreyaskumar R Patel  8 , Y Raja Rampersaud  9 , Arjun Sahgal  10 , Jeremy Reynolds  11 , Dean Chou  12 , Michael H Weber  13 , Michelle J Clarke  14
Affiliations
Review

A Systematic Review of Clinical Outcomes and Prognostic Factors for Patients Undergoing Surgery for Spinal Metastases Secondary to Breast Cancer

Daniel M Sciubba et al. Global Spine J. 2016 Aug.

Abstract

Study design: Review of the literature.

Objective: Surgery and cement augmentation procedures are effective palliative treatment of symptomatic spinal metastases. Our objective is to systematically review the literature to describe the survival, prognostic factors, and clinical outcomes of surgery and cement augmentation procedures for breast cancer metastases to the spine.

Methods: We performed a literature review using PubMed to identify articles that reported outcomes and/or prognostic factors of the breast cancer patient population with spinal metastases treated with any surgical technique since 1990.

Results: The median postoperative survival for metastatic breast cancer was 21.7 months (8.2 to 36 months), the mean rate of any pain improvement was 92.9% (76 to 100%), the mean rate of neurologic improvement was 63.8% (53 to 100%), the mean rate of neurologic decline was 4.1% (0 to 8%), and the local tumor control rate was 92.6% (89 to 100%). Kyphoplasty studies reported a high rate of pain control in selected patients. Negative prognostic variables included hormonal (estrogen and progesterone) and human epidermal growth factor receptor 2 (HER2) receptor refractory tumor status, high degree of axillary lymph node involvement, and short disease-free interval (DFI). All other clinical or prognostic parameters were of low or insufficient strength.

Conclusion: With respect to clinical outcomes, surgery consistently yielded neurologic improvements in patients presenting with a deficit with a minimal risk of worsening; however, negative prognostic factors associated with shorter survival following surgery include estrogen receptor/progesterone receptor negativity, HER2 negativity, and a short DFI.

Keywords: breast cancer; kyphoplasty; metastasis; spine; surgery; survival; tumor; vertebroplasty.

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Conflict of interest statement

Disclosures Daniel M. Sciubba, Consulting: Depuy-Synthes, Medtronic, Nuvasive, Stryker C. Rory Goodwin, Fellowship support: UNCF Merck Postdoctoral Fellowship; Grant: Burroughs Wellcome Fund and NREF Alp Yurter, none Derek Ju, none Ziya L. Gokaslan, Stock ownership: US Spine, Spinal Kinetics; Consulting, speaking, and teaching: AO Foundation; Research support: DePuy, NREF, AOSpine, AO North America Charles Fisher, Consulting: Medtronic, Nuvasive; Royalties: Medtronic; Research support: OREF, AOSpine, Medtronic Laurence D. Rhines, Consulting: Stryker, Globus Michael G. Fehlings, none Daryl R. Fourney, Travel expenses: AOSpine International; Grants: Asubio Pharmaceuticals, Canadian Institutes of Health Research, Spinal Cord Injury Solutions Network, Saskatchewan Health Research Foundation, AOSpine North America; Ownership, Proven Care Pathways, LLC (no payments received) Ehud Mendel, none Ilya Laufer, Consulting: SpineWave, DePuy/Synthes Chetan Bettegowda, none Shreyaskumar R. Patel, Consulting: Novartis, GSK, EMD Serono, Janssen, CytRx Y. Raja Rampersaud, Consulting: Medtronic Arjun Sahgal, Speaking and/or teaching arrangements: Medtronic Jeremy Reynolds, Support for travel to meetings: Nuvasive; Speaking and/or teaching arrangements: Globus, Medtronic; Fellowship support: DePuy/Synthes Dean Chou, Consulting: Orthofix, Medtronic, DePuy, Globus Michael H. Weber, none Michelle J. Clarke, none

Figures

Fig. 1
Fig. 1
Median or mean postoperative survival for metastatic breast cancer patients in months. Abbreviations: a, anterior decompression; m, mixed decompression (combined or including both single approaches); p, posterior decompression.
See this image and copyright information in PMC

References

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