Survival and Predictors in Patients With Breast Cancer Undergoing Surgery for Spinal Metastases: Insights From a Single-Center Cohort.

BACKGROUND: Breast cancer is the most commonly diagnosed malignancy among women globally, with spinal metastases significantly impacting morbidity and mortality. Surgical intervention plays a crucial role in managing symptomatic spinal lesions, yet prognostic factors and outcomes remain areas of active investigation. This study aims to evaluate survival rates and identify predictors in patients with breast cancer undergoing surgery for spinal metastases. METHODS: A retrospective analysis was conducted on 97 patients who underwent surgery for spinal breast cancer metastases at a single center over a 12-year period. Data included epidemiological and preoperative profiles, biological markers, and radiological findings. Survival outcomes were assessed using Kaplan-Meier analysis, and prognostic factors were analyzed via Cox regression. RESULTS: Postoperative overall survival rates were 72%, 64%, and 34% at 1, 2, and 5 years, respectively. Significant predictors of survival included tobacco use (HR 1.7, p = 0.025), estrogen receptor (HR 0.224, p = 0.03), triple-negative subtype (HR 4.1, p < 0.01), and lower Karnofsky scores (HR 0.488, p < 0.01). Spinal instability and preoperative neurological status did not significantly influence survival. Complications occurred in 17% of patients, with no 30-day mortality. CONCLUSION: This study provides one of the largest single-center experiences of surgery for spinal metastases from breast cancer in the modern treatment era. We found that overall preoperative performance and biological markers, remains a key predictor of survival, while neurological status, disease spread and spinal instability have no impact than in long-term survival. These results reflect advances in systemic therapy and surgical care, supporting surgery as an important part of multidisciplinary management for selected patients.