Elsevier

World Neurosurgery

Volume 114, June 2018, Pages e809-e817
World Neurosurgery

Original Article
Metastatic Spine Tumor Epidemiology: Comparison of Trends in Surgery Across Two Decades and Three Continents

https://doi.org/10.1016/j.wneu.2018.03.091Get rights and content

Highlights

  • Variations exist at local level in management of patients with spinal metastases.

  • Surgical habits have been consistent over time.

  • Overall survival has increased in recent years.

Background

Indications for surgery for symptomatic spinal metastases have become better defined in recent years, and suitable outcome measures have been established against a changing backdrop of patient characteristics, tumor behavior, and oncologic treatments. Nonetheless, variations still exist in the local management of patients with spinal metastases. In this study, we aimed to review global trends and habits in the surgical treatment of symptomatic spinal metastases, and to examine how these have changed over the last 25 years.

Methods

In this cohort study of consecutive patients undergoing surgery for symptomatic spinal metastases, data were collected using a secure Internet database from 22 centers across 3 continents. All patients were invited to participate in the study, except those unable or unwilling to give consent.

Results

There was a higher incidence of colonic, liver, and lung carcinoma metastases in Asian countries, and more frequent presentation of breast, prostate, melanoma metastases in the West. Trends in surgical technique were broadly similar across the centers. Overall survival rates after surgery were 53% at 1 year, 31% at 2 years, and 10% at 5 years after surgery (standard error 0.013 for all). Survival improved over successive time periods, with longer survival in patients who underwent surgery in 2011–2016 compared with those who underwent surgery in earlier time periods.

Conclusions

Surgical habits have been fairly consistent among countries worldwide and over time. However, patient survival has improved in later years, perhaps due to medical advances in the treatment of cancer, improved patient selection, and operating earlier in the course of disease.

Introduction

The contemporary spinal surgeon is becoming increasingly aware of spinal tumors; metastases are the most common neoplasms of the spine and will present in greater numbers as the global population ages.1 Due to differences in local management protocols, the decision to undergo surgery and choice of specific operations are likely to vary between geographic regions. Published studies examining spinal metastases are largely limited to the experience of single centers using a variety of tumor classification systems and outcomes measures, making it difficult to compare clinical practices.2, 3, 4, 5, 6, 7, 8, 9, 10 As a consequence, the differences in regional practices to treat spinal metastases remain poorly documented.

The Global Spinal Tumour Study Group (GSTSG) maintains an international, prospectively collected dataset on the surgical treatment of spinal metastases using a standardized classification system of surgical approaches and the EuroQol 5-Dimension (EQ-5D) health outcome measure to describe functional outcomes.2, 11 Here we describe the epidemiologic characteristics, surgical management, and outcomes of spinal metastatic disease in 10 countries in 4 different regions of the world to explore variations in surgical trends over time and region.

Section snippets

Inclusion/Exclusion Criteria

Patients diagnosed with spinal metastases between March 1991 and September 2016 at 22 referral centers in 10 countries throughout Asia (China, Korea, and Japan), mainland Europe (Belgium, Denmark, France, The Netherlands, and Spain), the United Kingdom, and North America (Canada and the United States) were recruited for entry into the GSTSG database. All patients underwent surgical intervention. Anonymized patient data was entered into the database directly by practitioners. Patients who were

Results

A total of 2148 patients with spinal metastases were admitted to the participating referral centers between March 1991 and September 2016 (Figure 1). After application of exclusion criteria, 2001 study participants remained (93.2%). The reasons for exclusion were incomplete follow-up in 5 patients (0.2%), insufficient patient details in 1 patient, and missing information on surgical approach in 141 patients (6.6%). The data were analyzed in 4 regions: the United Kingdom (UK), mainland Europe,

Regional Differences in Frequency of Tumor Types

In this study, the first global comparison of the surgical treatment of spinal metastases, we report wide variation in the frequency of metastatic tumor types across regions. The asymmetries observed in different parts of the world largely reflect those of primary cancer diagnoses in the respective regions. For example, the higher rates of gastrointestinal, liver, and lung carcinoma metastases in Asian centers reflects the high frequency of these primary cancers reported in Asia. Examining

Conclusions

In this first global comparison of the epidemiology, surgical approaches, and long-term survival in patients undergoing surgery for treatment of spinal metastases, we have found substantial regional variation in the composition of primary tumor types leading to spinal metastatic disease despite uniformity in the preferred surgical approach, surgical objectives, and long-term survival. The regional variation reported here should lend further support to the need for global collaboration, given

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  • Cited by (0)

    Conflict of interest statement: This work was funded by the Global Spine Tumour Study Group, a registered charity of England and Wales, Charity Commission number 1134934, and DePuy Synthes (Johnson & Johnson). This study was performed in part at University College London Biomedical Research Centre, which receives funding from the National Institute for Health Research, UK. The authors are members of the Global Spine Tumour Study Group. Other funders had no input in any aspect of the study or manuscript preparation. The authors disclose the following: M. Arts: stock or other ownership in Nuvasive, Vexim, Fagron, and Pharmine; consulting or advisory role for Amedica, Zimmer Biomet, Silony, and EIT; research funding from Zimmer Biomet, Amedica, Intrinsics, and EIT; patent, royalties, other intellectual property interests with EIT; J. Buchowski: consulting or advisory role, speakers' bureau, research funding, and travel, accommodations, and expenses from Globus Medical; patent, royalties, other intellectual property interests with Globus Medical, K2M, and Wolters Kluwer Health; M. Fehlings: consulting or advisory role with Pfizer, Zimmer Biomet, and InVivo Therapeutics; C. S. Lee, consulting or advisory role with U&I, Korea; research funding from Pfizer Korea; and patent, royalties, and other intellectual property interests with Solco, Korea and U&I, Korea; E. Massicotte: honoraria and travel, accommodations, and expenses from AO Spine North America; C. Mazel: stock or other ownership for Amplitude; honoraria from DePuy Spine, Medtronic, and Zimmer; consulting or advisory role for Ethicon; speakers' bureau: for DePuy Spine and Medtronic; patents, royalties, or other intellectual property interests with CHD; travel, accommodations, and expenses from DePuy, Medtronic, Zimmer, and Clariance; N. Quraishi: honoraria from AO Spine, Medtronic, and DePuy Synthes; speakers' bureau for AO Spine, Medtronic, and DePuy Synthes; travel, accommodations, and expenses from AO Spine, Medtronic, and DePuy Synthes; J. J. Verlaan: consulting or advisory role with and research funding from DePuy Synthes; M. Wang: stock or other ownership for Innovative Surgical Devices and Spinicity; consulting or advisory role with DePuy Spine, AesculapSpine, Jointax, and K2M; research funding from Department of Defence; patents, royalties, and other intellectual property interests with Children's Hospital of LA, DePuy Spine, Springer Publishing, and Quality Medical Publishing; D. Choi: research funding from DePuy Synthes. All other authors have nothing to disclose.

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