In 2007, Dr. Shehadi was a contributing author for a paper titled “Positive and negative prognostic variables for patients undergoing spine surgery for metastatic breast disease.” He and seven other doctors examined prognostic variables for patients who underwent metastatic breast cancer spinal surgery, and identified a few positive and negative variables. Below is the abstract and the conclusion of the study.
To read the full paper, click here.
The histology of the primary tumor in metastatic spine disease plays an important role in its treatment and prognosis. However, there is paucity in the literature of histology-specific analysis of spinal metastases. In this study, prognostic variables were reviewed for patients who underwent surgery for breast metastases to the spinal column. Respective chart review was done to first identify all patients with breast cancer over an 8-year period at a major cancer center and then to select all those with symptomatic metastatic disease to the spine who underwent spinal surgery. Univariate and multivariate analyses were used to assess several prognostic variables. Presence of visceral metastases, multiplicity of bony lesions, presence of estrogen receptors (ER), and segment of spine (cervical, thoracic, lumbar, sacral) in which metastases arose were compared with patient survival. Eighty-seven patients underwent 125 spinal surgeries. Those with estrogen receptor (ER) positivity had a longer median survival after surgery compared to those with estrogen receptor negativity. Patients with cervical location of metastasis had a shorter median survival compared with those having metastases in other areas of the spine. The presence of visceral metastases or a multiplicity of bony lesions did not have prognostic value. In patients with spinal metastases from breast cancer, aggressive surgical management may be an option for providing significant pain relief and preservation/improvement of neurological function. Interestingly, in patients undergoing such surgery, cervical location of metastasis is a negative prognostic variable, and ER-positivity is associated with better survival, while presence of visceral or multiple bony lesions does not significantly alter survival.
ER-positivity of the breast cancer was associated with better survival after surgery for spinal metastases, while cervical location of a spinal metastasis is a possible negative prognostic variable. Neither the number of vertebral bodies involved with tumor nor the presence of visceral metastases had prognostic significance in our series. Future reports on surgical outcomes for patients with metastatic spinal disease should be pathology-specific whenever possible, considering its paramount implications for optimal treatment and prognostication.
If you would like to learn more about this study or have questions, feel free to contact Dr. Shehadi today.