Introduction

Spinal metastases (SM) are a frequent complication of cancer and may lead to pathologic vertebral compression fractures (pVCF) and/or metastatic epidural spinal cord compression (MESCC). Based on autopsy studies, it is estimated that about one third of all cancer patients will develop SM. These data may not provide a correct estimation of the incidence in clinical practice.

Objective

This systematic review (SR) aims to provide a more accurate estimation of the incidence of SM, MESCC and pVCF in a clinical setting.

Methods

We performed a SR of papers regarding epidemiology of SM, pVCF, and MESCC in patients with solid tumors conform PRISMA guidelines. A search was conducted in the PubMed and Web of Science database using the terms epidemiology, prevalence, incidence, global burden of disease, cost of disease, spinal metastas*, metastatic epidural spinal cord compression, pathologic fracture, vertebral compression fracture, vertebral metastas* and spinal neoplasms. Papers published between 1975 and august 2021 were included. Quality was evaluated by the STROBE criteria.

Results

While 56 studies were included, none of them reports the actual definition used for MESCC and pVCF, inevitably introducing heterogenity. The overall cumulative incidence of SM and MESCC is 15.67% and 2.84% respectively in patients with a solid tumor. We calculated a mean cumulative incidence in patients with SM of 9.56% (95% CI 5.70%-13.42%) for MESCC and 12.63% (95% CI 7.00%-18.25%) for pVCF. Studies show an important delay between onset of symptoms and diagnosis.

Conclusions

While the overall cumulative incidence for clinically diagnosed SM in patients with a solid tumor is 15.67%, autopsy studies reveal that SM are present in 30% by the time they die, suggesting underdiagnosing of SM. Approximately 1 out of 10 patients with SM will develop MESCC and another 12.6% will develop a pVCF. Understanding these epidemiologic data, should increase awareness for first symptoms, allowing early diagnosis and subsequent treatment, thus improving overall outcome.

中文翻译：

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实体瘤患者脊柱转移瘤、转移性硬膜外脊髓压迫和病理性椎体压缩性骨折的流行病学：系统评价

介绍

脊柱转移瘤 (SM) 是癌症的常见并发症，可能导致病理性椎体压缩性骨折 (pVCF) 和/或转移性硬膜外脊髓压迫症 (MESCC)。根据尸检研究，估计大约三分之一的癌症患者会发展为 SM。这些数据可能无法正确估计临床实践中的发病率。

客观的

本系统评价 (SR) 旨在更准确地估计临床环境中 SM、MESCC 和 pVCF 的发生率。

方法

我们对符合 PRISMA 指南的实体瘤患者的 SM、pVCF 和 MESCC 的流行病学进行了 SR 论文。在 PubMed 和 Web of Science 数据库中使用术语流行病学、患病率、发病率、全球疾病负担、疾病成本、脊柱转移灶*、转移性硬膜外脊髓压迫、病理性骨折、椎体压缩性骨折、椎体转移灶*进行搜索和脊柱肿瘤。包括 1975 年至 2021 年 8 月之间发表的论文。质量通过 STROBE 标准进行评估。

结果

虽然纳入了 56 项研究，但没有一项研究报告了用于 MESCC 和 pVCF 的实际定义，不可避免地引入了异质性。实体瘤患者 SM 和 MESCC 的总体累积发生率分别为 15.67% 和 2.84%。我们计算出 MESCC 和 pVCF SM 患者的平均累积发病率为 9.56% (95% CI 5.70%-13.42%) 和 12.63% (95% CI 7.00%-18.25%)。研究表明，症状出现和诊断之间存在重要延迟。

结论

虽然实体瘤患者临床诊断为 SM 的总累积发病率为 15.67%，但尸检研究表明，到他们死亡时，SM 的发病率为 30%，这表明 SM 的诊断不足。大约十分之一的 SM 患者会发展为 MESCC，另外 12.6% 的人会发展为 pVCF。了解这些流行病学数据，应提高对首发症状的认识，从而实现早期诊断和后续治疗，从而改善总体结果。