A systematic review of clinical outcomes for patients diagnosed with skin cancer spinal metastases

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>Surgical procedures and/or adjuvant therapies are effective modalities for the treatment of symptomatic spinal metastases. However, clinical results specific to the skin cancer spinal metastasis cohort are generally lacking. The purpose of this study was to systematically review the literature for treatments, clinical outcomes, and survival following the diagnosis of a skin cancer spinal metastasis and evaluate prognostic factors in the context of spinal skin cancer metastases stratified by tumor subtype.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>The authors performed a literature review using PubMed, Embase, CINAHL, and Web of Science to identify articles since 1950 that reported survival, clinical outcomes, and/or prognostic factors for the skin cancer patient population with spinal metastases. The methodological quality of reviews was assessed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) tool.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Sixty-five studies met the preset criteria and were included in the analysis. Of these studies, a total of 25, 40, 25, and 12 studies included patients who underwent some form of surgery, radiotherapy, chemotherapy, or observation alone, respectively. Sixty-three of the 65 included studies were retrospective in nature (Class of Evidence [CoE] IV), and the 2 prospective studies were CoE II. Based on the studies analyzed, the median overall survival for a patient with a spinal metastasis from a primary skin malignancy is 4.0 months; survival by tumor subtype is 12.5 months for patients with basal cell carcinoma (BCC), 4.0 months for those with melanoma, 4.0 months for those with squamous cell carcinoma, 3.0 months for those with pilomatrix carcinoma, and 1.5 months for those with Merkel cell carcinoma (p &lt; 0.0001). The overall percentage of known continued disease progression after spine metastasis diagnosis was 40.1% (n = 244/608, range 25.0%–88.9%), the rate of known recurrence of the primary skin cancer lesion was 3.5% (n = 21/608, range 0.2%–100.0%), and the rate of known spine metastasis recurrence despite treatment for all skin malignancies was 2.8% (n = 17/608, range 0.0%–33.3%). Age greater than 65 years, sacral spinal involvement, presence of a neurological deficit, and nonambulatory status were associated with decreased survival in patients diagnosed with a primary skin cancer spinal metastasis. All other clinical or prognostic parameters were of low or insufficient strength.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Patients diagnosed with a primary skin cancer metastasis to the spine have poor overall survival with the exception of those with BCC. The median duration of survival for patients who received surgical intervention alone, medical management (chemotherapy and/or radiation) alone, or the combination of therapies was similar across interventions. Age, spinal region, and neurological status may be associated with poor survival following surgery.</jats:p></jats:sec>

Patient Characteristics Following Surgery for Spinal Metastases: A Multicenter Retrospective Study

“…In this study, 460 (79.31%) patients received palliative surgery including 290 posterior laminectomy, 155 subtotal corpectomy, and 15 subtotal corpectomy combined with microwave ablation and vertebroplasty. Most of them presented severe pain and spinal instability but the general conditions were good with KPS score more than 60 and Frankel score in D and E. The revised Tokuhashi score have suggested that surgery only be considered in patients with a life expectancy of more than 6 months, meaning that patients, especially those with aggressive primary tumor metastasis, are ineligible for surgical symptom palliation. However, in this multicenter case series, lung cancer was the most common metastasis, as seen in 198 patients.…”

A Systematic Review of Metastatic Hepatocellular Carcinoma to the Spine

“…18, 19 ‘High’ was assigned to studies that were Class of Evidence (CoE) I or II, and the true effect could be confidently assumed to be close to the estimated effect. ‘Low’ was assigned to studies that were Class III or IV, and the true effect may have been significantly different than the estimated effect.…”

“…‘Insufficient’ was assigned if there was very little confidence in the estimated result, no evidence, or too little evidence to estimate an effect. 19 The quality could be downgraded if the evidence was indirect, results were inconsistent, there were no a priori subgroup analyses or the effect estimates were imprecise. Conversely, overall estimation of quality could be upgraded if the magnitude of effect was large.…”

Minimally invasive versus conventional spine surgery for vertebral metastases: a systematic review of the evidence

“…as patients with lower life expectancies are liable to have complication profiles that far outweigh any potential benefit of surgery. Unfortunately, this means that many patients, especially those with metastases secondary to aggressive primary pathologies, such as lung cancer, pancreas cancer, and melanoma, are ineligible for surgical symptom palliation due to the aggressive course of their disease (22,26,28,29,33,38,65,66). In the past decade though, multiple groups have begun to publish the results of patients with degenerative spine pathologies treated with MIS techniques.…”