Elsevier

The Spine Journal

Volume 16, Issue 3, March 2016, Pages 322-328
The Spine Journal

Clinical Study
Surgical results of metastatic spinal cord compression (MSCC) from non–small cell lung cancer (NSCLC): analysis of functional outcome, survival time, and complication

https://doi.org/10.1016/j.spinee.2015.11.005Get rights and content

Abstract

Background Context

A number of studies have reported favorable surgical results for metastatic spinal tumors from various solid tumors. However, there are few data available on metastatic spinal cord compression (MSCC) from lung cancer despite its considerable frequency.

Purpose

The study aims to present the functional outcomes, survival time, and complications after surgical treatment for MSCC from non–small cell lung cancer (NSCLC).

Study Design/Setting

This is a longitudinal observational study.

Patient Sample

The study includes 50 patients who had neurologic deficit and underwent surgical treatment for MSCC from NSCLC.

Outcome Measures

The Eastern Cooperative Oncology Group performance status (ECOG-PS), ambulatory status, overall survival, factors associated with survival time, and perioperative complications were analyzed.

Methods

The postoperative changes of ECOG-PS and ambulatory status were assessed. The factors affecting postoperative ambulatory status were evaluated using logistic regression analysis. Survival time was calculated using the Kaplan-Meier method. To identify the prognostic factors, log-rank test and Cox hazards regression model were used for univariate and multivariate analyses, respectively. Major complications within postoperative 30 days and mortality rate were recorded.

Results

The study cohort consisted of 27 males and 23 females with a mean age of 58.0±11.3 years at the time of surgery. An ECOG-PS improvement by at least one grade was observed in 33 of 50 cases (66.0%). Among 39 patients who were not ambulatory before surgery, 23 patients (59.0%) regained ambulatory ability after surgery. Patients who were preoperatively ambulant and those who underwent surgery within 72 hours from neurologic deficit had an increased chance of postoperative ambulation. The median for overall survival after surgery was 5.2 months. Five prognostic factors were identified on univariate analysis: time from neurologic deficit, responsiveness to preoperative chemotherapy, postoperative chemotherapy, postoperative ECOG-PS, and postoperative ambulatory status. Multivariate analysis revealed that time to neurologic deficit (risk ratio [RR]: 2.28, p=.023), postoperative chemotherapy (RR: 6.58, p<.001), and postoperative ECOG-PS (RR: 2.73, p=.040) were independent prognostic factors of survival time. Major complications developed in 34.0% of patients (17 of 50), and the 30-day mortality rate was 10.0% (5 of 50).

Conclusions

Functional improvements were observed through surgical treatment even with relatively high complication rates for MSCC from NSCLC. Earlier surgical treatment could act as an adjuvant therapy for prolonging survival by improving functional status.

Introduction

Lung cancer is one of the leading causes of cancer-related death in men and women in the United States and accounts for approximately 20% of metastatic spinal cord compression (MSCC) [1], [2], [3]. Despite recent improvements in medical therapy, the prognosis of advanced lung cancer remains poor, with an expected survival time of less than 6 months [1], [4]. Thus, non-surgical treatments, such as radiotherapy with or without corticosteroids, have been preferred as first-line therapeutic modalities for the treatment of spinal metastases from lung cancer [5]. However, urgent surgical decompression is frequently required in patients with acute neurologic deterioration due to MSCC. Recent studies have proven that direct decompression surgery followed by radiation therapy is superior to radiation therapy alone for the treatment of MSCC [6], [7], [8]. Nonetheless, in the case of lung cancer, we tend not to recommend the surgical treatment even for acute neurologic deficit because of fear of short life expectancy and the potential risk of complications.

A number of studies have reported favorable surgical results for metastatic spinal tumors from various solid tumors [9], [10], [11], [12], [13]. However, to the best of our knowledge, few studies have focused on surgical treatment of MSCC from lung cancer despite its frequency. In the present study, we aimed to present the functional outcomes, survival time, and complications after surgical treatment for MSCC from non–small cell lung cancer (NSCLC) to provide information for decision making in this subgroup of patients.

Section snippets

Materials and methods

We prospectively followed up 50 NSCLC patients who underwent surgical treatment for acute or subacute neurologic deficit due to MSCC between March 2010 and June 2014. All patients were assessed using the same protocol to evaluate the oncological and functional status pre- and postoperatively. We only included subjects who presented with neurologic impairments, and excluded patients who had only axial pain without any neurologic deficit because the surgery might not be essential for these

Results

The study cohort consisted of 27 males and 23 females with a mean age of 58.0±11.3 years (range: 26.0–79.0) at the time of surgery. The mean time from development of neurologic deficit to surgery was 85.4±52.3 hours (range: 18.0–216.0). The thoracic spine was the most affected vertebrae, and posterior corpectomy followed by posterior fixation were the most common procedures (Table 1). Histology revealed adenocarcinoma in 27 patients and squamous cell carcinoma in 23 patients. The interval

Discussion

Non–small cell lung cancer is a quite common cancer and accounts for approximately 20% of all patients presenting with MSCC [2], [3]. Patients with MSCC from NSCLC have a worse prognosis compared with those with MSCC from other tumors, such as breast cancer, prostate cancer, and melanoma [3], [16], [17]. Recently, decompression surgery with or without radiotherapy has been considered the gold standard for MSCC treatment with good results [6], [7], [9], [10], [11], [12], [17]. Unfortunately, few

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    Author disclosures: SJP: Nothing to disclose. CSL: Nothing to disclose. SSC: Nothing to disclose.

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