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European Spine Journal

, Volume 16, Issue 10, pp 1659–1667 | Cite as

Positive and negative prognostic variables for patients undergoing spine surgery for metastatic breast disease

  • Daniel M. SciubbaEmail author
  • Ziya L. Gokaslan
  • Ian Suk
  • Dima Suki
  • Marcos V. C. Maldaun
  • Ian E. McCutcheon
  • Remi Nader
  • Richard Theriault
  • Laurence D. Rhines
  • Joseph A. Shehadi
Original Article

Abstract

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.

Keywords

Breast cancer Estrogen receptor Metastases Prognosis Spine surgery 

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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Daniel M. Sciubba
    • 1
    Email author
  • Ziya L. Gokaslan
    • 1
  • Ian Suk
    • 1
  • Dima Suki
    • 2
  • Marcos V. C. Maldaun
    • 2
  • Ian E. McCutcheon
    • 2
  • Remi Nader
    • 2
  • Richard Theriault
    • 3
  • Laurence D. Rhines
    • 2
  • Joseph A. Shehadi
    • 2
  1. 1.Department of NeurosurgeryJohns Hopkins UniversityBaltimoreUSA
  2. 2.Department of NeurosurgeryM.D. Anderson Cancer CenterHoustonUSA
  3. 3.Department of Breast Medical OncologyM.D. Anderson Cancer CenterHoustonUSA

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