Clinical Characteristics and Prognostic Analysis of Gynecologic Cancer with Spinal Metastases: A Single-Center Retrospective Study

Abstract

Objective: The purpose of this study is to provide key information on the clinical characteristics, surgical treatment, and potential prognostic factors in patients with metastatic spinal gynecologic cancer (MSGC), with a view to their application in clinical practice.

Methods: From January 2010 to January 2020, we performed a retrospective analysis of 14 patients with MSGC who underwent surgical treatment in a single center. Surgical treatment was performed on 14 patients, and a total of 14 operations were performed. The survival time of patients after spinal surgery was analyzed by Kaplan-Meier and Cox regression analysis.

Results: The average age of patients was 51.9 years (range 25‒70). The average time from initial surgery to the discovery of spinal metastasis was 60.3 months (2‒180), and the average follow-up time was 19.2 months (2‒55). Spinal tumor progression was found in 9 patients, and 12 patients (85.7%) died during follow-up. In univariate analysis, extraosseous visceral metastasis (p = 0.024), revised Tokuhashi stage (p = 0.025), Tomita stage (p = 0.005), and number of spinal lesions (p = 0.038) were associated with overall survival (OS). Extraosseous visceral metastasis (p = 0.026), revised Tokuhashi stage (p = 0.014), Tomita stage (p = 0.001), and gynecological cancer type (p = 0.039) were associated with progression-free survival.

Conclusion: Surgical treatment is an effective treatment for MSGC and relieves pain, restores function and rebuilds stability. Based on our single-center experience, extraosseous visceral metastasis, revised Tokuhashi stage, Tomita stage, and gynecological cancer type may be potential prognostic factors for OS.

Keywords: clinical prognosis; gynecological cancer; overall survival; progression-free survival; spinal metastasis; surgical treatment.

Figure 1

Radiographic and pathological images of a representative 30-year-old female patient (Case #12). (A) Preoperative X-ray. (B, C) Preoperative sagittal MRI scan revealing vertebral fracture caused by spinal metastases. (D) Bone scan revealing metastasis of the spine. (E, F) Postoperative X-rays of the thoracic spine. (G) Microphotography showing significant nuclear pleomorphism with prominent nucleoli (H&E, original magnification 100×).

Figure 2

Radiographic and pathological images of a representative 57-year-old female patient (Case #9). (A, D) Preoperative CT and MRI scan revealing vertebral metastases. (B, C) Positron emission tomography-computed tomography revealing metastases of the spine. (E, F) Postoperative X-rays of the lumbar spine. (G) Microphotography showing significant nuclear pleomorphism with prominent nucleoli (H&E, original magnification 100×).

Figure 3

Radiographic and pathological images of a representative 67-year-old female patient (Case #8). (A, B) Preoperative X-rays. (C, D) Preoperative MRI revealing vertebral metastases. (E, F) X-ray images of the thoracic spine obtained postoperatively. (G) Microphotography showing significant nuclear pleomorphism with prominent nucleoli (H&E, original magnification 100×).

Figure 4

(A) Overall survival of all patients enrolled in our study. (B) Progression-free survival of all patients enrolled in our study.

Figure 5

Univariate analysis of prognostic factors affecting overall survival. (A) Extraosseous visceral metastasis (p = 0.024). (B) Revised Tokuhashi stage (p = 0.025). (C) Tomita stage (p = 0.005). (D) Surgery (p = 0.365). (E) Number of spinal lesions (p = 0.038). (F) Types of gynecological cancer (p = 0.111).

Figure 6

Univariate analysis of prognostic factors affecting progression-free survival. (A) Extraosseous visceral metastasis (p = 0.026). (B) Revised Tokuhashi stage (p = 0.014). (C) Tomita stage (p = 0.001). (D) Surgery (p = 0.422). (E) Number of spinal lesions (p = 0.135). (F) Types of gynecological cancer (p = 0.039).