Analysis of postoperative survival and risk factors in patients with spinal metastases from non-small cell lung cancer

English Keywords:Non-small cell lung cancer  Spinal metastasis  Surgical treatment

English Abstract:

  【Abstract】 Objectives: To investigate the postoperative survival and risk factors in patients with spinal metastases from non-small cell lung cancer. Methods: The data of 105 patients with non-small cell lung cancer and spinal metastases who were surgically treated at our hospital between January 2012 and January 2022 were retrospectively collected. The patients were divided into three groups based on the surgical procedure, corpectomy with bone cement isolation group(n=33), piecemeal total spondylectomy group(n=46), and total en bloc spondylectomy group(n=26). Demographic characteristics, laboratory test results, radiological examination findings(including spinal involvement, non-spinal bone metastases, visceral metastases, etc.) and pathological examination results were recorded. Patients′ neurological function and general condition were assessed using the Frankel classification, Karnofsky performance scale(KPS) score and Eastern Cooperative Oncology Group(ECOG) score preoperatively and at 1-year follow-up. The 1-year survival rate was evaluated using the Kaplan-Meier method. Risk factors affecting prognosis were identified through univariate analysis(Log-rank test) and confirmed by multivariate analysis(Cox regression model). Results: All the cases had good postoperative recovery. Six cases developed incision infections, of which five healed after antibiotic treatment and dressing changes, while one healed after debridement. Seven cases experienced cerebrospinal fluid leakage, and four developed pleural effusions; All recovered after symptomatic treatment. The average follow-up time was 14.4±7.3 months. The average KPS score of the patients improved from 65.4±18.0 preoperatively to 75.1±17.6 postoperatively. The proportion of patients classified as Frankel grades D and E increased from 65.7% before surgery to 81.0% after surgery. The proportion of patients with ECOG scores of 0-1 increased from 40.0% preoperatively to 69.5% postoperatively. The overall survival of the 105 patients was 19.8±1.4 months, and the recurrence-free survival was 15.1±0.8 months. According to Cox regression analysis, preoperative ECOG score(P=0.002), visceral metastasis(P<0.001), surgical procedure(P=0.02), and immunotherapy(P=0.002) were the independent risk factors affecting the overall survival of patients with spinal metastases from non-small cell lung cancer after surgery. Conclusions: Surgical treatment can significantly improve the neurological function and general condition of patients with spinal metastases from lung cancer. There are no significant differences in the alleviation of clinical symptoms between different surgical methods, but total en bloc vertebrectomy can effectively reduce postoperative tumor recurrence. Preoperative ECOG score, visceral metastasis, surgical approach and immunotherapy are independent risk factors affecting the overall survival of patients.