Analysis of Skeletal-Related Events in a Liaison Treatment for Metastatic Spinal Tumors: A 10-Year Retrospective Study

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Introduction: Skeletal-related events (SREs), including pathological fractures and spinal cord compression, significantly reduce the quality of life and survival in patients with metastatic spinal tumors. Although multidisciplinary "liaison treatment" has been implemented at our institution to detect and manage all metastatic spinal lesions, some patients still develop SREs. This study aims to analyze the characteristics and circumstances of patients who experienced SREs despite this system, with particular focus on referrals from other hospitals. Methods: We reviewed patients who developed SREs between December 2013 and December 2023 at our institution. Clinical data including age, sex, performance status (PS), spinal instability neoplastic score (SINS), primary tumor type, spinal lesion level, histologic subtype, epidural spinal cord compression (ESCC) grade, and timing of spine intervention were analyzed. PS at initial and final visits was compared using the Wilcoxon signed-rank test. Results: Among 1,479 patients with metastatic spinal tumors, 72 (4.8%) developed SREs. Median age was 71 years; 69% were male. PS significantly improved from 3.1 to 2.4 (p=0.0002). SINS averaged 8.9, with 72.4% of cases showing intermediate instability. Thoracic spine involvement was most frequent (59.7%). Prostate, lung, and breast cancers accounted for over 50% of cases. ESCC grade ≥II was present in 62.5%. Notably, 54.2% (39/72) were referred after the onset of an SRE; 77% of these occurred at other hospitals. Furthermore, 69.5% had no prior cancer diagnosis before the SRE. Conclusions: Despite an in-house liaison system, SREs frequently occurred in patients referred from external institutions. Early recognition of red-flag symptoms, such as back pain in cancer patients and timely referral for imaging and specialist evaluation are essential. Regional collaboration and education are crucial to prevent avoidable SREs.

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