# Oncology Biomarkers, Clinical Characteristics, and Survival Outcomes in Colorectal Cancer Patients with Spinal Metastases Undergoing Spinal Surgery: Insights from a Retrospective Cohort Study

## TL;DR

This study explores factors affecting survival in colorectal cancer patients with spinal metastases, finding that CK20 expression and tumor recurrence are linked to shorter survival, while surgery improves quality of life.

## Contribution

The study identifies CK20 expression and spinal tumor recurrence as novel prognostic factors for survival in colorectal cancer patients with spinal metastases.

## Key findings

- CK20 expression and spinal tumor recurrence are significantly associated with shorter post-metastasis survival.
- Surgical treatment improves neurological function and quality of life in patients with spinal metastases.
- The median post-metastasis survival is 3.0 years, with most patients having extraspinal metastases.

## Abstract

Colorectal cancer can metastasize to the spine, leading to significant complications such as pain, neurological deficits, and impaired mobility. This study examines clinical factors and biological markers that influence survival in patients with spinal metastasis from colorectal cancer. Analysis of demographics, tumor markers, surgical outcomes, and survival revealed that CK20 expression and the recurrent spinal tumors may be linked to shorter post-metastasis survival. Additionally, surgical treatment was associated with improved neurological function, enhancing patients’ quality of life. These insights could help guide future treatment strategies and improve patient care. Further prospective research with larger patient cohorts is necessary to validate these results and refine approaches for managing spinal metastases from colorectal cancer.

Objectives: This study aims to identify clinical characteristics and biomarkers influencing survival outcomes in colorectal cancer (CRC) patients with spinal metastases. Methods: We conducted a retrospective cohort study involving 27 patients treated for CRC-derived spinal metastases at Johns Hopkins Hospital. Data on demographics, biomarker profiles of the primary colorectal tumor site, surgical outcomes, and survival were collected. Neurological function was assessed pre- and postoperatively using Frankel scores. Survival outcomes included overall survival (OS) and post-metastasis survival. Results: The median age of the patients was 58 years, with 63% being women. The sacral spine was the most frequently involved site (59.3%), followed by the thoracic and lumbar regions. Most patients (89%) already had extraspinal metastases, predominantly in the lungs. Biomarker analysis showed microsatellite stability in 63% of patients and CDX2 (Caudal-type homeobox 2) expression in 37%. Laminectomy was performed in 85% of cases and sacrectomy in 55.6%, leading to postoperative improvements in ambulatory function and neurological status. The main indications included local recurrence of the tumor and neurological deficits attributed to the impinging tumor. The median overall survival was 4.9 years, while the median post-metastasis survival was 3.0 years. Univariable analysis revealed that CK20 expression (p = 0.041) and spinal tumor recurrence (p = 0.045) were significantly associated with shorter post-metastasis survival. Conclusions: This study highlights the prognostic importance of CK20 expression and spinal tumor recurrence in CRC patients diagnosed with spinal metastases. Surgical intervention significantly improved neurological outcomes, enhancing patient quality of life. Further research with larger cohorts is needed to confirm these findings and optimize treatment strategies for this challenging patient population.