K.K. Rascheskova2, 3, R.Sh. Khasanov2, I.R. Safin1, 2
1Republican Clinical Oncology Dispensary named after prof. M.Z. Sigal, Kazan
2Kazan State Medical Academy — branch campus of the FSBEI FPE RMACPE MOH Russia, Kazan
3City Clinical Hospital No. 7 named after M.N. Sadykov, Kazan
Rascheskova K.K. — neurosurgeon of the Neurosurgical Department, Lecturer of the Department of Surgery, Assistant Lecturer of the Department of Surgical Diseases, Faculty of Postgraduate Education
11 Mushtari St., 420012 Kazan, Russian Federation, tel.: +7 (843) 267-61-52, e-mail: rascheskovakarina@yandex.ru, ORCI ID: 0009-0001-1150-682X
Abstract. Metastatic spinal injury (MSI) is a serious and growing clinical and epidemiological problem in modern oncology. Its relevance is due to two key factors: increased overall life expectancy of cancer patients due to advances in systemic therapy and, as a result, increased frequency of late complications, including distant metastases. The spine is one of the most frequent targets for hematogenous metastasis in a number of malignant tumors. This leads to severe consequences such as pathological fractures, spinal cord compression, chronic pain syndrome, and a sharp decrease in the quality of life.
In this study, we analyzed the MSI epidemiological situation in the Republic of Tatarstan in 2023. The study is retrospective observational and was performed at Republican Clinical Oncological Dispensary. The analysis focused on four nosologies with the greatest known predisposition to spinal damage: breast, prostate, lung, and kidney cancers. The work included anonymized data from 1,131 patients with established stage IV of these diseases, which ensured the sample representativeness. The study followed the ethical principles of the Helsinki Declaration.
The results revealed a significant incidence of MSI among patients with disseminated cancer. The highest rates were recorded for prostate cancer (66.2%) and breast cancer (61.0%). In lung and kidney cancers, metastases to the spine were found in 43.0 and 32.2% of patients, respectively. Particular attention was drawn to the analysis of the risk of pathological fractures, which turned out to be maximal in breast (36.2% of the number of patients with MSI) and kidney cancers (25.6%). This pattern is well explained by the mainly lytic (bone-destroying) nature of metastases of these tumors, which makes the spine extremely vulnerable.
The regional data demonstrated consistency with national epidemiological trends, but they also highlighted a systemic problem – the lack of a unified national registry of MSI patients. This gap significantly complicates the development of unified clinical protocols, resource planning, timely routing of patients to specialized specialists, and an objective assessment of both therapeutic and preventive measures’ effectiveness.
Thus, the study highlights the urgent need to introduce specialized registry for this category of patients. It is extremely important to develop multidisciplinary programs that would consolidate the efforts of oncologists, neurosurgeons, radiotherapists, specialists in radiation diagnostics and palliative care. Such an integrated approach is the key to improving the early diagnosis of metastatic lesions, effective prevention of severe complications, reducing disability and, ultimately, improving the quality of life of patients while optimizing the use of health system resources.
Key words: metastatic spinal lesion, epidemiology, pathological fracture, breast cancer, prostate cancer, lung cancer, kidney cancer, organization of oncological care