Department of Molecular Medicine and Surgery, Section of Orthopaedics and Sports Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
Acta Orthop. 2011 Feb;82(1):96-101. doi: 10.3109/17453674.2011.552779. Epub 2011 Feb 1.
Most lung cancer patients with skeletal metastases have a short survival and it is difficult to identify those patients who will benefit from palliative surgery. We report complication and survival rates in a consecutive series of lung cancer patients who were operated for symptomatic skeletal metastases.
This study was based on data recorded in the Karolinska Skeletal Metastasis Register. The study period was 1987-2006. We identified 98 lung cancer patients (52 females). The median age at surgery was 62 (34-88) years. 78 lesions were located in the femur or spine.
The median survival time after surgery was 3 (0-127) months. The cumulative 12-month survival after surgery was 13% (95% CI: 6-20). There was a difference between the survival after spinal surgery (2 months) and after extremity surgery (4 months) (p = 0.03). Complete pathological fracture in non-spinal metastases (50 patients) was an independent negative predictor of survival (hazard ratio (HR) = 1.8, 95% CI: 1-3). 16 of 31 patients with spinal metastases experienced a considerable improvement in their neurological function after surgery. The overall complication rate was 20%, including a reoperation rate of 15%.
Bone metastases and their subsequent surgical treatment in lung cancer patients are associated with high morbidity and mortality. Our findings will help to set appropriate expectations for these patients, their families, and surgeons.
大多数患有骨骼转移的肺癌患者生存时间较短，难以确定哪些患者将从姑息性手术中获益。我们报告了一系列连续的肺癌患者因骨骼转移所致症状而行手术治疗的并发症和生存率。
本研究基于 Karolinska 骨骼转移登记处记录的数据。研究期间为 1987 年至 2006 年。我们确定了 98 例肺癌患者（52 例女性）。手术时的中位年龄为 62 岁（34-88 岁）。78 处病变位于股骨或脊柱。
手术后的中位生存时间为 3 个月（0-127 个月）。手术后 12 个月的累积生存率为 13%（95%CI：6-20）。脊柱手术后的生存时间（2 个月）与四肢手术后的生存时间（4 个月）存在差异（p = 0.03）。非脊柱转移灶完全病理性骨折（50 例）是生存的独立负预测因素（危险比（HR）= 1.8，95%CI：1-3）。31 例脊柱转移患者中有 16 例在手术后神经功能显著改善。总体并发症发生率为 20%，包括再手术率为 15%。
肺癌患者的骨骼转移及其随后的手术治疗与高发病率和死亡率相关。我们的研究结果将有助于为这些患者、他们的家人和外科医生设定适当的预期。
