Ghaith Abdul Karim, Yang Xinlan, Khalilullah Taha, Wang Xihang, Alfonzo Horowitz Melanie, Khalifeh Jawad, Ahmed A Karim, Azad Tej, Weinberg Joshua, Al-Mistarehi Abdel-Hameed, Foster Chase, Bhimreddy Meghana, Menta Arjun K, Redmond Kristin J, Theodore Nicholas, Lubelski Daniel
Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA.
Department of Neurosurgery, School of Medicine, Ohio State University, Columbus, OH 43210, USA.
Cancers (Basel). 2025 Apr 21;17(8):1374. doi: 10.3390/cancers17081374.
BACKGROUND/OBJECTIVES: Spinal metastases are a common and severe complication of lung cancer, particularly in small cell lung cancer (SCLC), and are associated with poor survival. Despite advancements in treatment, optimal management strategies remain unclear, with significant differences between non-small cell lung cancer (NSCLC) and SCLC. This study evaluates treatment patterns, survival outcomes, and prognostic factors in lung cancer patients with spinal metastases, integrating deep learning survival prediction models.
This retrospective cohort study analyzed the National Cancer Database (NCDB) to identify NSCLC and SCLC patients diagnosed with spinal metastases. Demographics and treatment modalities were analyzed and adjusted for age, sex, and comorbidities. Kaplan-Meier analysis and Cox proportional hazards models assessed overall survival (OS). Five advanced survival prediction models estimated 1-year and 10-year mortality, with feature importance determined via permutation analysis.
Among 428,919 lung cancer patients, 5.1% developed spinal metastases, with a significantly higher incidence in SCLC (13.6%) than in NSCLC (5.1%). SCLC patients had poorer OS. Radiation therapy alone was the predominant treatment, and stereotactic body radiation therapy (SBRT) predicted better short- and long-term survival compared to other radiation techniques. High-dose radiation (71-150 Gy BED) improved OS in NSCLC, while reirradiation benefited NSCLC but had a limited impact in SCLC. SurvTrace demonstrated the highest predictive accuracy for 1-year and 10-year mortality, identifying age, radiation dose, reirradiation, and race as key prognostic factors.
The management of spinal metastases requires a histology-specific approach. Radiation remains the primary treatment, with SBRT predicting better short- and long-term survival. High-dose radiation and reirradiation should be considered for NSCLC, while the benefits are limited in SCLC. These findings support histology-specific treatment strategies to improve survival of patients with metastatic lung cancer to the spine.
背景/目的：脊柱转移是肺癌常见且严重的并发症，尤其是在小细胞肺癌（SCLC）中，并且与生存率低相关。尽管治疗取得了进展，但最佳管理策略仍不明确，非小细胞肺癌（NSCLC）和SCLC之间存在显著差异。本研究结合深度学习生存预测模型，评估肺癌脊柱转移患者的治疗模式、生存结果和预后因素。
这项回顾性队列研究分析了国家癌症数据库（NCDB），以识别诊断为脊柱转移的NSCLC和SCLC患者。分析了人口统计学和治疗方式，并根据年龄、性别和合并症进行了调整。采用Kaplan-Meier分析和Cox比例风险模型评估总生存期（OS）。五个先进的生存预测模型估计了1年和10年死亡率，并通过排列分析确定特征重要性。
在428,919例肺癌患者中，5.1%发生了脊柱转移，SCLC的发生率（13.6%）显著高于NSCLC（5.1%）。SCLC患者的OS较差。单纯放疗是主要治疗方式，与其他放疗技术相比，立体定向体部放疗（SBRT）预测短期和长期生存率更高。高剂量放疗（生物等效剂量71 - 150 Gy）改善了NSCLC的OS，再次放疗对NSCLC有益，但对SCLC影响有限。SurvTrace对1年和10年死亡率的预测准确性最高，确定年龄、放疗剂量、再次放疗和种族为关键预后因素。
脊柱转移的管理需要组织学特异性方法。放疗仍然是主要治疗方法，SBRT预测短期和长期生存率更高。NSCLC应考虑高剂量放疗和再次放疗，而对SCLC的益处有限。这些发现支持组织学特异性治疗策略，以提高肺癌脊柱转移患者的生存率。
