Compresión medular metastásica: incidencia, epidemiología y factores pronóstico

Epidemiology of spinal metastases, metastatic epidural spinal cord compression and pathologic vertebral compression fractures in patients with solid tumors: A systematic review

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The clinical incidence of spinal metastases is 15.67%, two thirds are metastases from breast-, prostate- or lung cancer.

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9.6% of patients with spinal metastases develop metastatic epidural spinal cord compression.

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1 out of 8 (12.6%) of patients with spinal metastases suffer of pathologic vertebral compression fractures.

Introduction

Spinal metastases (SM) are a frequent complication of cancer and may lead to pathologic vertebral compression fractures (pVCF) and/or metastatic epidural spinal cord compression (MESCC). Based on autopsy studies, it is estimated that about one third of all cancer patients will develop SM. These data may not provide a correct estimation of the incidence in clinical practice.

Objective

This systematic review (SR) aims to provide a more accurate estimation of the incidence of SM, MESCC and pVCF in a clinical setting.

Methods

We performed a SR of papers regarding epidemiology of SM, pVCF, and MESCC in patients with solid tumors conform PRISMA guidelines. A search was conducted in the PubMed and Web of Science database using the terms epidemiology, prevalence, incidence, global burden of disease, cost of disease, spinal metastas*, metastatic epidural spinal cord compression, pathologic fracture, vertebral compression fracture, vertebral metastas* and spinal neoplasms. Papers published between 1975 and august 2021 were included. Quality was evaluated by the STROBE criteria.

Results

While 56 studies were included, none of them reports the actual definition used for MESCC and pVCF, inevitably introducing heterogenity. The overall cumulative incidence of SM and MESCC is 15.67% and 2.84% respectively in patients with a solid tumor. We calculated a mean cumulative incidence in patients with SM of 9.56% (95% CI 5.70%-13.42%) for MESCC and 12.63% (95% CI 7.00%-18.25%) for pVCF. Studies show an important delay between onset of symptoms and diagnosis.

Conclusions

While the overall cumulative incidence for clinically diagnosed SM in patients with a solid tumor is 15.67%, autopsy studies reveal that SM are present in 30% by the time they die, suggesting underdiagnosing of SM. Approximately 1 out of 10 patients with SM will develop MESCC and another 12.6% will develop a pVCF. Understanding these epidemiologic data, should increase awareness for first symptoms, allowing early diagnosis and subsequent treatment, thus improving overall outcome.

Comparison of the postoperative pain change and spinal stenosis rate between percutaneous vertebroplasty combined with radiofrequency ablation and with 125I particle implantation in the treatment of metastatic spinal cord compression: A retrospective study

Background context

Metastatic spinal cord compression (MSCC) seriously affects the survival rate.

Objective

The therapeutic effects of two treatment strategies for MSCC: percutaneous vertebroplasty (PVP) combined with radiofrequency ablation (RFA) and PVP combined with ¹²⁵I particle implantation, were compared.

Study design

Retrospective study.

Patient sample

40 patients with MSCC were divided into two groups: 19 cases in the RFA group and 21 cases in the ¹²⁵I group.

Method

All patients were accessed to determine the differences in pain, which was evaluated using the visual analog scale (VAS) at 1 week, 1 month, and 3 months after the operation, and spinal stenosis rates (SSRs), which were measured at 1 and 3 months after the operation, between the two groups.

Results

The VAS scores and SSRs at baseline were comparable between the RFA group and the ¹²⁵I group (7.19 ​± ​2.07 vs 7.42 ​± ​1.95, 37.7% ​± ​11.2% vs 41.1% ​± ​11.4%). The VAS scores and SSRs at 1 month and 3 months after the operation were significantly reduced in both groups, compared with those at baseline. The VAS scores and SSRs in the ¹²⁵I group were lower than those in the RFA group at 3 months after the operation (1.09 ​± ​0.97 vs 1.75 ​± ​1.06 p ​= ​0.048 and 12.3% ​± ​6.4% vs 18.1% ​± ​10.1% p ​= ​0.034), while the VAS scores at 1 week after the operation in the RFA group were lower than those in the ¹²⁵I group (4.39 ​± ​1.34 vs 5.05 ​± ​1.82 p ​= ​0.049).

Conclusion

PVP combined with RFA has a slight advantage in relieving pain in the short term, while PVP combined with ¹²⁵I particle implantation may have a better effect in the relieving pain and decreasing the SSRs at 3 months after the operation.

Predictors of overall survival in non-small-cell lung cancer patients with metastatic spinal cord compression treated with short-course radiotherapy

Metastatic spinal cord compression (MSCC) is a condition that impacts directly on the patient's prognosis.

OBJECTIVE

The study purpose was to identify predictors of overall survival in non-small-cell lung cancer (NSCLC) patients with MSCC.

METHODS

A cohort study involving NSCLC patients enrolled between 2008 and 2017 was performed. Sixty-four patients treated with short-course radiotherapy were included. Clinical and socio-demographic data were extracted from medical records. Data were analysed using survival analysis and Cox proportional hazard regression analysis.

RESULTS

The median survival time was 2.5 months (95% CI: 1.6-3.5). Patients >60 years had shorter survival than younger patients (HR 1.85; 95% CI 1.06-3.24; p = 0.02), and patients with performance status (PS) >2 had shorter survival than those with PS≤2 (HR 1.93; 95% CI 1.12-3.33; p = 0.01).

CONCLUSION

This study found worse PS and higher age are independent predictors of overall survival in NSCLC patients with MSCC treated with short-course radiotherapy after adjusting the potential confounding factors (PS, age and target therapy).