Approaching spinal metastases spread profile.

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.