Tsuang Fon-Yih, Jeon Jin Pyeong, Huang An-Ping, Chai Chung Liang
Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
Spine Tumor Center, National Taiwan University Hospital, Taipei, Taiwan.
Neurospine. 2023 Jun;20(2):567-576. doi: 10.14245/ns.2245026.513. Epub 2023 Jun 30.
The long-term survival data of lung cancer patients with spinal metastases are crucial for informed treatment decision-making. However, most studies in this field involve small sample sizes. Moreover, survival benchmarking and an analysis of changes in survival over time are required, but data are unavailable. To meet this need, we performed a metaanalysis of survival data from small studies to obtain a survival function based on largescale data.
We performed a single-arm systematic review of survival function following a published protocol. Data of patients who received surgical, nonsurgical, and mixed modes of treatment were meta-analyzed separately. Survival data were extracted from published figures with a digitizer program and then processed in R. Median survival time was used as an effect size for moderator analysis to explain the heterogeneity.
Sixty-two studies with 5,242 participants were included for pooling. The survival functions showed a median survival of 6.72 months for surgery (95% confidence interval [CI], 61.9-7.01; 2,367 participants; 36 studies), 5.99 months for nonsurgery (95% CI, 5.33-6.47; 891 participants; 12 studies), and 5.96 months for mixed (95% CI, 5.67-6.43; 1,984 participants; 18 studies). Patients enrolled since 2010 showed the highest survival rates.
This study provides the first large-scale data for lung cancer with spinal metastasis that allows survival benchmarking. Data from patients enrolled since 2010 had the best survival and thus may more accurately reflect current survival. Researchers should focus on this subset in future benchmarking and remain optimistic in the management of these patients.
肺癌脊柱转移患者的长期生存数据对于明智的治疗决策至关重要。然而，该领域的大多数研究样本量较小。此外，需要生存基准以及对生存随时间变化的分析，但目前尚无可用数据。为满足这一需求，我们对小型研究的生存数据进行了荟萃分析，以基于大规模数据获得生存函数。
我们按照已发表的方案对生存函数进行了单臂系统评价。分别对接受手术、非手术和混合治疗模式的患者数据进行荟萃分析。使用数字化程序从已发表的图表中提取生存数据，然后在R软件中进行处理。中位生存时间用作效应量进行调节分析，以解释异质性。
纳入62项研究，共5242名参与者进行汇总分析。生存函数显示，手术组的中位生存期为6.72个月（95%置信区间[CI]，6.19 - 7.01；2367名参与者；36项研究），非手术组为5.99个月（95%CI，5.33 - 6.47；891名参与者；12项研究），混合组为5.96个月（95%CI，5.67 - 6.43；1984名参与者；18项研究）。2010年以来入组的患者生存率最高。
本研究提供了首个关于肺癌脊柱转移的大规模数据，可用于生存基准比较。2010年以来入组患者的数据生存情况最佳，因此可能更准确地反映当前的生存状况。研究人员在未来的基准比较中应关注这一亚组，并对这些患者的管理保持乐观态度。
