Clinical Presentation and Management of Breast Cancer With Vertebral Metastasis: A Retrospective Cohort Study in Tunisia

Background Breast cancer is the most common malignancy affecting women, and vertebral metastases are a frequent complication. This study aimed to examine the clinical and anatomical characteristics, therapeutic management, and prognostic factors associated with vertebral metastases from breast carcinomas in patients from south-eastern Tunisia. Materials and methods This descriptive cohort analytical study utilized retrospectively collected data and was conducted in the medical oncology and orthopaedic surgery departments at the Gabes University Hospital over a five-year period, from January 2015 to December 2019. Clinical, pathological, and therapeutic data were statistically analysed to identify prognostic factors influencing overall survival. Results The study included 57 patients with a median age of 48 years. Metastases were metachronous in 41 patients (71.9%) and synchronous in 16 (28.1%). Tumours were classified as T4 in 42.1% of study cases. Spinal metastases mainly affected two vertebral levels in 61.4% of patients and involved three vertebrae in 70.2% of cases. Spinal cord compression was the most common complication (24.6%). Extravertebral bone, pulmonary, hepatic, and brain metastases were observed in 80.7%, 43.9%, 49.1%, and 12.3% of patients. Hormone receptors and human epidermal growth factor receptor (HER2) were expressed in 73.3% and 19.3% of cases, respectively. No patients underwent surgery for spinal metastasis. Breast radiotherapy was administered in 52.6% of cases, of which 42.1% targeted spinal metastases. Median survival was 28 months. Overall survival at three and five years was 38.6% and 22.7%, respectively. Significant prognostic factors for overall survival included age (p=0.041) and metastatic disease at diagnosis (p=0.01). Conclusion Vertebral bone metastases can compromise the neurological outcomes. However, various systemic and local therapeutic options are available for managing vertebral metastasis. A multidisciplinary approach is essential to optimise strategies and improve prognosis.