Department of Orthopaedics, Peking University Third Hospital, Beijing, China.
Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China.
Orthop Surg. 2023 Jan;15(1):70-78. doi: 10.1111/os.13571. Epub 2022 Nov 4.
Spinal metastases of lung cancer (SMLC) usually have high degree of malignancy and require surgical treatment. However, there are several controversies about the efficacy of surgery. This study aimed to investigate factors predicting prognosis of SMLC after surgery-based comprehensive treatment.
A cohort of 112 cases of SMLC who underwent surgical treatment between 2009 and 2020 were retrospectively reviewed and analyzed. The surgical strategies included total en-bloc spondylectomy, debulking surgery, palliative decompression, and vertebral augmentation procedures. The patients were regularly followed-up. Survival analysis was performed, as well as analysis of the patients' neurological recovery, pain relief, and improvement of Karnosky performance score (KPS). Cox regression was used to analyze influencing factors of survival time, and Kaplan-Meier method was performed in survival analysis.
The cohort included 63 males and 49 females, with an average age of 60.6 ± 10.6 years. Median survival time was 16 months. A total of 86.7% of paralysis patients' neurological function recovered and 83.9% of patients with low KPS score (10-40) improved. Surgical method was significantly correlated with improvement of neurological function (p < 0.001) and KPS (p < 0.001). The mean bleeding volume was 502 ml and operative time was 170 min. The survival rates at 3, 6, 12, 24, and 36 months were 92.0%, 80.4%, 63.4%, 63.4%, and 22.6%, respectively. Postoperative Frankel grade (p < 0.001), postoperative KPS score (p = 0.001), and application of molecular targeted drugs (p < 0.001) were significantly correlated with survival time in univariate analysis, while application of molecular targeted drugs was an independent predictor for a longer survival by a multivariate analysis.
Surgery-based comprehensive treatment brought a fair outcome, with elongated survival time. Surgery can significantly improve patients' neurological function and physical performance status. Adjuvant targeted therapy is an independent positive factor for patients' survival.
肺癌脊柱转移（SMLC）通常具有高度恶性，需要手术治疗。然而，手术的疗效存在一些争议。本研究旨在探讨影响 SMLC 患者术后综合治疗预后的因素。
回顾性分析了 2009 年至 2020 年间接受手术治疗的 112 例 SMLC 患者的病例资料。手术策略包括全脊椎整块切除术、减瘤术、姑息性减压术和椎体增强术。患者定期随访。进行生存分析，并分析患者的神经恢复、疼痛缓解和卡氏功能状态评分（KPS）的改善情况。采用 Cox 回归分析生存时间的影响因素，并进行 Kaplan-Meier 生存分析。
该队列包括 63 名男性和 49 名女性，平均年龄为 60.6±10.6 岁。中位生存时间为 16 个月。86.7%的瘫痪患者神经功能恢复，83.9%的 KPS 评分（10-40）较低的患者得到改善。手术方法与神经功能恢复（p<0.001）和 KPS 改善（p<0.001）显著相关。平均出血量为 502ml，手术时间为 170min。术后 3、6、12、24 和 36 个月的生存率分别为 92.0%、80.4%、63.4%、63.4%和 22.6%。单因素分析显示，术后 Frankel 分级（p<0.001）、术后 KPS 评分（p=0.001）和分子靶向药物的应用（p<0.001）与生存时间显著相关，而多因素分析显示，分子靶向药物的应用是生存时间延长的独立预测因素。
基于手术的综合治疗带来了较好的疗效，延长了生存时间。手术能显著改善患者的神经功能和身体活动状态。辅助靶向治疗是患者生存的独立正性因素。
