Department of Neurosurgery, La Pitié Salpétrière Hospital, Paris, France.
Department of Neurosurgery, Bretonneau Hospital, Tours, France.
Surg Oncol. 2019 Dec;31:61-66. doi: 10.1016/j.suronc.2019.08.007. Epub 2019 Sep 5.
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.
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.
A prospective French national multicenter database.
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.
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 L, bladder for L (p = 0.0025), breast for C (p = 0.006), Prostate for L-L (p = 0.002-0.04), multiple myelomas for C, p = 0.03, T-T (p < 0.0001-0.025) and L-L (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).
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.
脊柱转移会导致严重的发病率。脊柱是癌症转移最常见的部位，但转移对脊柱的偏好尚未完全了解。
本研究旨在更好地描述脊柱转移的分布。我们研究的主要目的是了解恶性细胞如何在脊柱内扩散，并确定转移途径的有效图谱或特征。
一项前瞻性法国多中心数据库研究。
2014 年 1 月至 2017 年期间，740 例脊柱转移（SpM）患者接受治疗。对脊柱病变的解剖分布进行分类。
170 例患者（占系列的 22.9%）出现颈椎 SpM，440 例（60%）出现腰椎 SpM，530 例（71.6%）发生在胸椎体水平。转移更常发生在椎体（645 例，87.2%）而不是后位（278 例，37.6%，p<0.0001）。212/740 例（28.6%）患者出现脊柱周围受累（体部和后位）。404 例患者（54.6%）出现伴随的硬脊膜炎。原发性颈部肿瘤向颈椎转移：耳鼻喉（34.8%，p=0.049）、甲状腺（33.3%，p=0.043），而盆腔肿瘤则针对腰椎：前列腺（72%，p=0.011）、膀胱（75%，p=0.047）。所有肿瘤均表现出对胸椎的趋化性。确定了与肿瘤相关的重要椎体：肺（p=0.004）和甲状腺（p=0.028）为 L，膀胱为 L（p=0.0025），乳房为 C（p=0.006），前列腺为 L-L（p=0.002-0.04），多发性骨髓瘤为 C，p=0.03，T-T（p<0.0001-0.025）和 L-L（p=0.004-0.027）。脊柱是最后一个受转移影响的器官，中位无进展生存期为 4.2 个月（标准差 1.8，p=0.001）。
尽管我们确定某些肿瘤在特定椎体水平具有显著的定位倾向，但目前就脊柱转移特征得出结论还为时过早。迄今为止，根据脊柱转移的这种图谱，在影像学随访或预防性治疗方面提供建议还为时过早。
