Massive Spondylectomy for Metastatic Spinal Cord Compression From Non-Small-Cell Lung Cancer With Local Failure After Radiotherapy

Lung Cancer
02/09/2020

Global Spine J. 2020 May 7:2192568220919099. doi: 10.1177/2192568220919099. Online ahead of print.

ABSTRACT

STUDY DESIGN.: A retrospective multivariate analysis.

OBJECTIVE.: To analyze clinical outcomes of surgical treatment and prognostic factors of local failure after stereotactic body radiation therapy (SBRT) in patients with spinal metastatic non-small-cell lung cancer (NSCLC).

METHODS.: This study included patients with metastatic spinal cord compression (MSCC) from spinal NSCLC after radiotherapy who received massive spondylectomy for circumferential decompression of spinal cord and reconstruction of spinal stability in our center between May 2006 and February 2017. Neurological function was evaluated using the Frankel score. Overall survival (OS) was estimated by the Kaplan-Meier method. Factors with Pvalues ≤.1 were subjected to multivariate analysis for OS by proportional hazard analysis. Values of P<.05 were considered statistically significant.

RESULTS.: The mean age of the 55 included patients (36 male and 19 female) was 57.76 ± 8.94 (median 58, range 36-77) years, with a mean postoperative OS of 14.98 ± 14.81 (median 10.0, range 1-84) months. Neurological function was improved in 46 (83.6%) of the 55 patients after surgery. Prognostic analysis suggested that preoperative frankel score (FS) score, visceral metastasis, D-dimer (D-D) level, and neutrophil/lymphocyte ratio (NLR) were independent prognostic factors for selected patients.

CONCLUSIONS.: Massive spondylectomy could provide circumferential decompression and improve the neurological function of patients with MSCC from spinal NSCLC after radiotherapy. A preoperative FS score of C/D, no visceral metastasis, D-D <1000 μg/L, and NLR <5 are predictors of better prognosis.