Approaching spinal metastases spread profile

Abstract

Background: Spinal metastases cause significant morbidity. The vertebral column is the most common site of cancer metastasis, however predilection of metastases for the spine is not fully understood.

Objective: The aim of the present investigation was to obtain a better description of the distribution of spinal metastases. The main objective of our study was to figure out how malignant cells disseminate within the spine and determine a potent mapping or profile of the metastatic spread routes.

Study design: A prospective French national multicenter database.

Methods: 740 consecutive patients were treated for spine metastasis (SpM) between January 2014 and 2017. A categorisation of the anatomical distribution of spine lesions was conducted.

Results: One hundred and seventy patients (22.9% of series) presented cervical SpM, 440 (60%) lumbar SpM, and a majority 530 (71.6%) at the thoracic vertebral level. Metastases were more often present in the vertebral body (645 patients, 87.2%) than in a posterior location (278 patients, 37.6%, p < 0.0001). 212/740 patients (28.6%) presented circumferential spine involvement (body and posterior elements). An associated epiduritis was presented in 404 patients (54.6%). Primitive neck tumors spread towards the cervical spine: ENT (34.8%, p = 0.049), thyroid (33.3%, p = 0.043) whereas pelvic tumors targeted the lumbar spine: prostate (72%, p = 0.011), bladder (75%, p = 0.047). All tumors presented a tropism for thoracic vertebrae. Significant tumor/vertebrae associations were identified: lung (p = 0.004) and thyroid (p = 0.028) for L₁, bladder for L₅ (p = 0.0025), breast for C₆ (p = 0.006), Prostate for L₁-L₄ (p = 0.002-0.04), multiple myelomas for C₇, p = 0.03, T₃-T₇ (p < 0.0001-0.025) and L₁-L₄ (p = 0.004-0.027). Spine was the latest organ affected by metastases with a median-free survival of 4.2 months (SD 1.8, p = 0.001).

Conclusions: Although we determined that some tumors have a significant propensity to localise at certain vertebral level, it remains premature to conclude on a spinal metastases profile. To date, it is too early to provide recommendations in imaging follow-up or in preventive therapeutic based on this mapping of spine metastases.

Keywords: Epiduritis; Metastatic spreading; Spine metastases; Survival; Vertebrae.