Armstrong V, Schoen N, Madhavan K, Vanni S
Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA.
Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA.
J Clin Neurosci. 2019 Apr;62:66-71. doi: 10.1016/j.jocn.2019.01.006. Epub 2019 Jan 14.
Seventy percent of cancer patients will have metastatic bone disease, most commonly in the vertebra. Prognosis of metastatic lung cancer is poor and treatment is mostly palliative. To-date, there is no systematic review on the ideal treatment for lung cancer with spinal metastases in regards to mortality. Literature searches were performed based on PRISMA guidelines for systematic review. Thirty-nine studies comprising 1925 patients treated for spinal metastases of lung cancer met inclusion criteria. All analyses were performed using SAS and SPSS. Data were analyzed for meaningful comparisons of baseline patient characteristics, primary cancer type, metastatic lesion characteristics, treatment modality, and clinical and radiologic outcomes. Significantly greater mean survival length was seen in the non-surgical group (8.5 months, SD 6.6, SEM 0.17) compared to the surgical group (7.5 months, SD 4.5, SEM 0.25; p = 0.013). There was no statistically significant survival difference between different types of primary lung cancer: NSCLC (8.3 months, SD 13.8, SEM 0.91) and SCLC (7.0 months, SD 4.6, SEM 0.46; p = 0.36). Number of vertebral levels involved per lesion also did not exhibit significant difference: single lesion (11.3 months, SD 6.8, SEM 2.2) and multiple lesions (13.8 months, SD 15.7, SEM 3.6; p = 0.64). For patients with symptomatic spinal metastases from lung cancer, non-operative approaches experience significantly better survival outcomes (p = 0.013). Future clinical studies are needed to determine the best treatment algorithm to help maximize outcomes and minimize mortality in metastatic lung cancer.
70%的癌症患者会发生骨转移，最常见于脊椎。转移性肺癌的预后较差，治疗大多为姑息性治疗。迄今为止，关于肺癌脊柱转移的理想治疗方法在死亡率方面尚无系统评价。根据PRISMA系统评价指南进行文献检索。39项研究共纳入1925例接受肺癌脊柱转移治疗的患者，符合纳入标准。所有分析均使用SAS和SPSS进行。对数据进行分析，以对患者基线特征、原发性癌症类型、转移病灶特征、治疗方式以及临床和影像学结果进行有意义的比较。与手术组（7.5个月，标准差4.5，标准误0.25；p = 0.013）相比，非手术组的平均生存长度显著更长（8.5个月，标准差6.6，标准误0.17）。不同类型的原发性肺癌之间在生存方面无统计学显著差异：非小细胞肺癌（8.3个月，标准差13.8，标准误0.91）和小细胞肺癌（7.0个月，标准差4.6，标准误0.46；p = 0.36）。每个病灶累及的椎体节段数也无显著差异：单个病灶（11.3个月，标准差6.8，标准误2.2）和多个病灶（13.8个月，标准差15.7，标准误3.6；p = 0.64）。对于有症状的肺癌脊柱转移患者，非手术治疗方法的生存结局显著更好（p = 0.013）。未来需要进行临床研究以确定最佳治疗方案，以帮助最大限度地提高转移性肺癌的治疗效果并降低死亡率。
