Medical Student Drexel University College of Medicine Paoli, PA, US
Introduction: Renal cell carcinoma (RCC) is a common malignancy with a high propensity to metastasize to the spine, leading to complex treatment challenges and reduced survival. In this study, we evaluated the prevalence of oncological biomarkers in patients with RCC spinal metastases and analyzed how these biomarkers, along with clinical factors, impact survival outcomes.
Methods: We conducted a retrospective analysis of patients with RCC who underwent surgical resection of spinal metastases at Johns Hopkins Hospital between 2013 and 2022. Two survival metrics—overall survival and survival following spinal metastasis—were the primary outcomes for this study. Demographic, clinical, and immunohistochemical biomarker expression data were collected. Log-rank tests were used to identify significant survival differences based on clinical and biomarker factors. Cox regression analyses were used to determine independent predictors of survival.
Results: A total of 33 patients were included in this study, with a median age of 61 years. Primary tumor resection and preoperative ambulatory status were significantly associated with higher overall survival (99.6 vs. 22.8 months, p=0.017; and 61.2 vs. 15.6 months, p=0.012, respectively). CAM5.2 expression was associated with lower overall survival (14.4 vs. 61.2 months, p=0.001). Survival following spinal metastasis was significantly lower in patients with lung metastases (8.4 vs. 19.2 months, p=0.032) and those expressing CAM5.2 or EMA (6.0 vs. 15.6 months for both, p=0.016 and p=0.039, respectively), while primary tumor resection was associated with improved survival post-spinal metastasis (37.2 vs. 8.4 months, p=0.012). Cox regression identified postoperative non-ambulatory status (HR 7.98;95%CI 1.932-32.922; p=0.004) and CAM5.2 expression (HR 11.00; 95%CI 2.393-50.584; p=0.002) as independent risk factors for mortality. Lung metastasis (HR 2.45; 95%CI 1.037-5.769; p=0.041) and primary tumor resection (HR 0.35; 95%CI 0.136-0.899; p=0.029) were significant predictors of survival following spinal metastasis.
Conclusion : The oncological profile of RCC spinal metastases plays a critical role in survival outcomes, particularly with biomarkers like CAM5.2 and clinical factors such as ambulatory status and primary tumor resection. CAM5.2 and non-ambulatory status were associated with decreased survival, while primary tumor resection correlated with improved survival.