Antar Albert, Xia Yuanxuan, Al-Mistarehi Abdel-Hameed, Papali Pritika, Alfonzo Horowitz Melanie, Sriram Shreya, Sattari Shahab Aldin, Weber-Levine Carly, Neerumalla Sushanth, Mendelson Benjamin Z, Lee Sang, Redmond Kristin J, Bydon Ali, Witham Timothy F, Theodore Nicholas, Lubelski Daniel
School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA.
School of Medicine, West Virginia University, Morgantown, WV 26506, USA.
Curr Oncol. 2025 Jun 4;32(6):331. doi: 10.3390/curroncol32060331.
Prostate cancer with spinal metastases (PCSM) is associated with high morbidity and mortality. The impact of biomarkers on the prognosis of spinal metastases, however, remains unclear.
This study explored associations between potential biomarkers, treatment modalities, survival, and neurological outcomes in PCSM patients.
We conducted a retrospective analysis of 68 patients as part of a neurosurgical cohort with PCSM at a comprehensive cancer center from 2013 to 2023, examining the influence of potential biomarkers, treatment modalities, and demographics on prognosis. The primary outcomes were the identification of biomarkers, overall survival (OS) in years, survival after spinal metastasis in years, spinal metastasis recurrence, and postoperative neurological outcomes via Frankel scores.
All the patients (n = 68) had adenocarcinoma, and the median age was 69 years. The mortality rate was 66% with a median OS of 6 years. Seventy-two biomarkers were identified. An accelerated failure time model (AFT) showed that radiotherapy to the prostate increased the OS (TR = 1.805, = 0.001), while smoking status (TR = 0.625, < 0.001) and gene mutations (TR = 0.504, = 0.006) were associated with decreased OS. Kaplan-Meier analysis associated mutations with reduced median OS using the Gehan-Breslow-Wilcoxon test (3.50 vs. 9.49 years; = 0.001). mutations were trending towards but were not significant for decreased survival following spinal metastases (2.04 vs. 3.15 years; = 0.08). Both ( = 0.02) and (, = 0.01) mutations were associated with increased spinal metastasis recurrence when analyzed using Fisher's exact test. No differences were observed in the median OS or survival after spinal metastases among patients with or without androgen receptor splice variant-7 (AR-V7), prostate-specific membrane antigen (PSMA), , or other analyzed biomarkers. Similarly, neither age, receipt of chemotherapy, nor radiotherapy to the spine correlated with OS. Only chemotherapy was associated with a decreased postoperative Frankel Score ( = 0.002).
mutations and smoking status were associated with decreased OS in patients with PCSM. Both and mutations were associated with increased spinal metastasis recurrence. Receipt of radiotherapy to the prostate was correlated with prolonged survival, whereas receipt of radiotherapy to the spine was not. Chemotherapy was associated with decreased postoperative neurological outcomes.
伴有脊柱转移的前列腺癌（PCSM）与高发病率和死亡率相关。然而，生物标志物对脊柱转移预后的影响仍不明确。
本研究探讨PCSM患者潜在生物标志物、治疗方式、生存率和神经学结果之间的关联。
我们对2013年至2023年在一家综合癌症中心的68例作为神经外科队列一部分的PCSM患者进行了回顾性分析，研究潜在生物标志物、治疗方式和人口统计学因素对预后的影响。主要结局包括生物标志物的鉴定、以年为单位的总生存期（OS）、脊柱转移后的生存期（以年为单位）、脊柱转移复发情况以及通过Frankel评分评估的术后神经学结果。
所有患者（n = 68）均为腺癌，中位年龄为69岁。死亡率为66%，中位OS为6年。共鉴定出72种生物标志物。加速失效时间模型（AFT）显示，前列腺放疗可提高OS（TR = 1.805，P = 0.001），而吸烟状况（TR = 0.625，P < 0.001）和 基因突变（TR = 0.504，P = 0.006）与OS降低相关。Kaplan-Meier分析使用Gehan-Breslow-Wilcoxon检验将 基因突变与降低的中位OS相关联（3.50年对9.49年；P = 0.001）。 基因突变在脊柱转移后的生存期降低方面有趋势但不显著（2.04年对3.15年；P = 0.08）。使用Fisher精确检验分析时， 和 基因突变均与脊柱转移复发增加相关（P = 0.02和P = 0.01）。在有或没有雄激素受体剪接变体-7（AR-V7）、前列腺特异性膜抗原（PSMA）、 或其他分析的生物标志物的患者中，中位OS或脊柱转移后的生存期未观察到差异。同样，年龄、是否接受化疗或脊柱放疗均与OS无关。只有化疗与术后Frankel评分降低相关（P = 0.002）。
基因突变和吸烟状况与PCSM患者的OS降低相关。 和 基因突变均与脊柱转移复发增加相关。前列腺放疗与生存期延长相关，而脊柱放疗则不然。化疗与术后神经学结果降低相关。
