Preoperative Function, Previous SERM Treatment, and Triple-Negative Tumor Status are Independently Associated With 3-Month Postoperative Function After Surgical Decompression of Metastatic Breast Cancer

Abstract

Background: The most common cancer in women worldwide, breast cancer most often metastasizes to the bone. Improved chemo- and radiotherapies and novel molecular therapies have prolonged survival in women with osseous metastatic breast cancer, but spinal metastases often cause cord compression that degrades their functional independence. Purpose: In women with breast cancer metastasized to the spine, we sought to (1) identify independent predictors of a functional deficit 3 months after surgical management and (2) assess the utility of existing metrics at highlighting patients at risk of a postoperative functional deficit. Methods: We performed a single-institution, retrospective analysis of 92 patients meeting our inclusion criteria between 2004 and 2021. Patients were classified by 3-month postoperative Eastern Cooperative Oncology Group (ECOG) scores into good/independent (ECOG 0 to 2) and poor/dependent (ECOG 3 to 5) functional outcome groups. Univariate and multivariate analyses were performed to identify patient and tumor factors associated with good vs. poor 3-month ECOG scores. Results: Preoperative use of selective estrogen receptor modulators (SERMs) was significantly associated with good postoperative functional outcomes. Poor preoperative function, the presence of visceral metastases at the time of surgery, and triple-negative primary or metastatic tumor status were independently associated with poor 3-month postoperative function. Host characteristics, sociodemographic factors, and indicators of surgical complexity, including estimated blood loss, front/back surgery, and corpectomy reconstruction, were not associated with 3-month ECOG score. A multivariate model including these significant univariate associations and normalized for patient demographics identified preoperative SERM use, poor preoperative function (ECOG score), and triple-negative primary or metastatic tumor status as independently associated with functional status 3 months after surgery. Conclusions: Our retrospective analysis found that preoperative SERM use was significantly associated with improved postoperative functional outcomes, while poor preoperative function and triple-negative tumor status were significantly associated with poor function 3 months after surgery. These factors may serve as indicators of function and independence after surgery for patients with metastatic breast cancer to the spine. Level of Evidence: Level IV: Prognostic Study