• Julia B Duvall, Elie Massaad, Layla Siraj, Ali Kiapour, Ian Connolly, Muhamed Hadzipasic, Aladine A Elsamadicy, Theresa Williamson, Ganesh M Shankar, Andrew J Schoenfeld, Mitchell S Fourman, and John H Shin.
• Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
• Neurosurgery. 2023 Jan 1; 92 (1): 839183-91.

BackgroundBreast cancer molecular features and modern therapies are not included in spine metastasis prediction algorithms.ObjectiveTo examine molecular differences and the impact of postoperative systemic therapy to improve prognosis prediction for spinal metastases surgery and aid surgical decision making.MethodsThis is a retrospective multi-institutional study of patients who underwent spine surgery for symptomatic breast cancer spine metastases from 2008 to 2021 at the Massachusetts General Hospital and Brigham and Women's Hospital. We studied overall survival, stratified by breast cancer molecular subtype, and calculated hazard ratios (HRs) adjusting for demographics, tumor characteristics, treatments, and laboratory values. We tested the performance of established models (Tokuhashi, Bauer, Skeletal Oncology Research Group, New England Spinal Metastases Score) to predict and compare all-cause.ResultsA total of 98 patients surgically treated for breast cancer spine metastases were identified (100% female sex; median age, 56 years [IQR, 36-84 years]). The 1-year probabilities of survival for hormone receptor positive, hormone receptor positive/human epidermal growth factor receptor 2+, human epidermal growth factor receptor 2+, and triple-negative breast cancer were 63% (45 of 71), 83% (10 of 12), 0% (0 of 3), and 12% (1 of 8), respectively ( P < .001). Patients with triple-negative breast cancer had a higher proportion of visceral metastases, brain metastases, and poor physical activity at baseline. Postoperative chemotherapy and endocrine therapy were associated with prolonged survival. The Skeletal Oncology Research Group prognostic model had the highest discrimination (area under the receiver operating characteristic, 0.77 [95% CI, 0.73-0.81]). The performance of all prognostic scores improved when preoperative molecular data and postoperative systemic treatment plans was considered.ConclusionSpine metastases risk tools were able to predict prognosis at a significantly higher degree after accounting for molecular features which guide treatment response.Copyright © Congress of Neurological Surgeons 2022. All rights reserved.

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