Zhong Guoqing, Chen Yonghan, Lai Huahao, He Jingzhe, Huang Chongquan, Yan Yuan, Cheng Shi, Zhang Yu
School of Medicine, South China University of Technology, Guangzhou, Guangdong, China.
Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China.
Ann Surg Oncol. 2025 Sep 23. doi: 10.1245/s10434-025-18332-3.
Surgical intervention for lung cancer-derived spinal metastasis (LCSM) is frequently associated with significant intraoperative hemorrhage.
This prospective cohort study aimed to identify clinical predictors of intraoperative blood loss (IOBL) and red blood cell transfusion requirements in patients undergoing LCSM surgery.
Consecutive patients treated surgically for LCSM at a tertiary medical center between January 2017 and August 2024 were prospectively enrolled. Demographic, surgical, and laboratory variables were evaluated, including epidermal growth factor receptor (EGFR) mutation status, metastatic burden, and coagulation profiles. Multivariable linear regression models were used to quantify associations with IOBL and transfusion volume.
Among 163 patients, mean IOBL was 765 ± 890 mL, with 54.6% requiring red blood cell transfusions (mean 4.9 ± 2.9 units). Transfused patients demonstrated 3.8-fold greater blood loss than their non-transfused counterparts (1151.7 vs 300.9 mL, p < 0.001). Key independent predictors of IOBL included EGFR mutation (β = 309.7 mL, p = 0.012), lumbar metastases (β = 288.7 mL, p = 0.038), surgical duration (168.7 mL/h, p < 0.001), laminectomy levels (284.3 mL/level, p < 0.001), and elevated preoperative international normalized ratio (β = 1156.9 mL, p = 0.018). Predictors of transfusion volume paralleled these findings, with EGFR mutation (β = 1.33 units, p = 0.002) and laminectomy levels (β = 0.75 units/level, p = 0.003) demonstrating dose-dependent relationships.
This study identified EGFR mutation as a novel molecular predictor of hemorrhagic risk in LCSM surgery, independent of systemic therapy status. The quantifiable impact of procedural complexity and coagulation dysfunction provides actionable thresholds for preoperative optimization. These findings enable stratified blood management protocols, particularly for EGFR-mutated cohorts requiring multilevel decompression.
肺癌衍生脊柱转移瘤（LCSM）的手术干预常伴有术中大量出血。
这项前瞻性队列研究旨在确定接受LCSM手术患者术中失血量（IOBL）和红细胞输血需求的临床预测因素。
前瞻性纳入2017年1月至2024年8月在一家三级医疗中心接受LCSM手术治疗的连续患者。评估人口统计学、手术和实验室变量，包括表皮生长因子受体（EGFR）突变状态、转移负担和凝血指标。使用多变量线性回归模型量化与IOBL和输血量的关联。
163例患者中，平均IOBL为765±890 mL，54.6%的患者需要红细胞输血（平均4.9±2.9单位）。输血患者的失血量比未输血患者多3.8倍（1151.7对300.9 mL，p<0.001）。IOBL的关键独立预测因素包括EGFR突变（β=309.7 mL，p=0.012）、腰椎转移（β=288.7 mL，p=0.038）、手术持续时间（168.7 mL/h，p<0.001）、椎板切除节段（284.3 mL/节段，p<0.001）和术前国际标准化比值升高（β=1156.9 mL，p=0.018）。输血量的预测因素与这些结果相似，EGFR突变（β=1.33单位，p=0.002）和椎板切除节段（β=0.75单位/节段，p=0.003）呈剂量依赖性关系。
本研究确定EGFR突变是LCSM手术出血风险的一种新的分子预测因素，与全身治疗状态无关。手术复杂性和凝血功能障碍的可量化影响为术前优化提供了可操作的阈值。这些发现有助于制定分层血液管理方案，特别是对于需要多级减压的EGFR突变队列。
