Igarashi Tomoyuki, Okamoto Keigo, Teramoto Koji, Kaku Ryosuke, Ishida Keiko, Ueda Keiko, Kawaguchi Yo, Hori Tetsuo, Hashimoto Masayuki, Kitamura Shoji, Tezuka Noriaki, Hanaoka Jun
Department of Surgery, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan.
Department of Medical Oncology, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan.
Mol Clin Oncol. 2017 May;6(5):770-774. doi: 10.3892/mco.2017.1199. Epub 2017 Mar 17.
Vertebral metastasis of non-small-cell lung cancer (NSCLC) often leads to neurological paralysis, with deterioration of the patients' activities of daily living (ADL). Surgical treatments for the symptoms are unlikely to be recommended due to the poor prognosis of patients with advanced NSCLC. The aim of the present study was to retrospectively evaluate the clinical outcome of posterior spinal fixation surgery in patients with neurological paralysis resulting from vertebral metastasis of NSCLC. Between April, 2007 and March, 2012, 4 patients (3 men and 1 woman; median age, 56.5 years) underwent fixation surgery at the Shiga University of Medical Science Hospital (Otsu, Japan). The mean preoperative Tokuhashi and Tomita scores of the patients were high (8.25 and 7.0, respectively). However, the Frankel grade functional score and performance status of the patients improved following fixation surgery, after which all patients received chemoradiotherapy. Postoperatively, the median paralysis-free time was 41 months (range, 17-42 months) and the median survival time was 42.5 months (range, 22-43 months). According to the functional scores, the patients had a poor prognosis, which may have been a contraindication for fixation surgery. In these cases, however, surgical treatment improved the patients' ADL and increased the likelihood of receiving anticancer therapy, contributing to the prolongation of survival. Therefore, fixation surgery may be beneficial for patients with neurological paralysis following vertebral metastasis of advanced NSCLC.
非小细胞肺癌（NSCLC）的椎体转移常导致神经麻痹，患者的日常生活活动（ADL）恶化。由于晚期NSCLC患者预后较差，不太可能推荐针对这些症状的手术治疗。本研究的目的是回顾性评估非小细胞肺癌椎体转移导致神经麻痹患者后路脊柱固定手术的临床结果。2007年4月至2012年3月期间，4例患者（3例男性和1例女性；中位年龄56.5岁）在滋贺医科大学医院（日本大津）接受了固定手术。患者术前Tokuhashi和Tomita评分的平均值较高（分别为8.25和7.0）。然而，患者的Frankel分级功能评分和体能状态在固定手术后有所改善，此后所有患者均接受了放化疗。术后，中位无麻痹时间为41个月（范围17 - 42个月），中位生存时间为42.5个月（范围22 - 43个月）。根据功能评分，患者预后较差，这可能是固定手术的一个禁忌证。然而，在这些病例中，手术治疗改善了患者的ADL，并增加了接受抗癌治疗的可能性，有助于延长生存期。因此，固定手术可能对晚期非小细胞肺癌椎体转移后出现神经麻痹的患者有益。
