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.
目的：本研究旨在明确影响结直肠癌（CRC）伴脊柱转移患者生存结局的临床特征及生物标志物。方法：我们对约翰·霍普金斯医院收治的27例结直肠癌来源脊柱转移患者开展回顾性队列研究，收集人口统计学特征、原发结直肠肿瘤部位的生物标志物谱、手术结局及生存数据。术前及术后采用Frankel评分评估神经功能。生存结局包括总生存期（OS）和转移后生存期。结果：患者中位年龄为58岁，其中63%为女性。骶椎是最常见的受累部位（59.3%），其次为胸椎和腰椎区域。多数患者（89%）已存在脊柱外转移，以肺部转移为主。生物标志物分析显示63%的患者存在微卫星稳定状态，37%的患者表达CDX2（尾型同源框转录因子2）。85%的病例接受椎板切除术，55.6%接受骶骨切除术，术后患者行走功能及神经状态均得到改善。主要手术指征包括肿瘤局部复发及肿瘤压迫导致的神经功能缺损。中位总生存期为4.9年，中位转移后生存期为3.0年。单变量分析显示CK20表达（p=0.041）与脊柱肿瘤复发（p=0.045）与较短的转移后生存期显著相关。结论：本研究揭示了CK20表达与脊柱肿瘤复发对确诊脊柱转移的结直肠癌患者具有重要预后价值。手术干预显著改善神经功能结局，提升了患者生活质量。未来需通过更大规模队列研究验证这些发现，以优化这一临床挑战性患者群体的治疗策略。
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