Metastatic Renal Cell Carcinoma to the Spine: Outcomes and Morbidity: Single-Center Experience

Abstract

Renal cell carcinoma with metastases to the spine (RCCMS) requires a multidisciplinary approach. We reviewed our institutional experience with RCCMS patients undergoing spinal surgery in order to identify factors that may affect clinical outcomes, survival, and complications. Patients with RCCMS who underwent operative intervention from 2007 to 2020 were reviewed retrospectively. Forty-four patients with the diagnosis of RCCMS were identified. Pain was the most common symptom, and neurologic dysfunction was present in one third of cases. Thoracic spine was the most common location (N= 27), followed by the lumbar (N= 12) and cervical (N= 5) regions. The overall survival from diagnosis of renal cell carcinoma was 25 (2- 194) months and 8 (0.3- 92) months after spinal surgery. Gender, age, spinal level, postoperative radiation, and nephrectomy had no bearing on survival. Survival for patients with a Tokuhashi score of 0- 8, 9- 11, and 12- 15 was 6.5 (1.5- 23.5), 8.9 (0.3- 91.6), and 23.4 (2.5- 66) months, respectively (P= 0.03). The postoperative American Spinal Cord Injury Association score of E (hazard ratio 0.109 [95% confidence interval 0.022- 0.534, P= 0.006) also bore a significant influence on survival. There was a total of 10 complications in 7 of 44 (16%) patients. Median postoperative survival of patients with RCCMS was 8 (0.3- 92) months. Higher Tokuhashi score and ASIA E score at follow-up correlated with improved overall survival. Complication rate was 16%. Spinal surgery in RCCMS is indicated for the preservation of function and prevention of neurologic deterioration. Multimodality therapy with improved chemotherapy and stereotactic spinal radiation is expected to impact quality and length of survival positively.