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Surgical Impacts of Metastatic Non-small Cell Lung Cancer to the Thoracic and Lumbar Spine

Journal of Korean Medical Science 2021년 36권 7호 p.52 ~ 52
정종명, 현승재, 김기정,
소속 상세정보
정종명 ( Jung Jong-Myung ) - Gachon University College of Medicine Gachon University Gil Medical Center Department of Neurosurgery
현승재 ( Hyun Seung-Jae ) - Seoul National University College of Medicine Seoul National University Bundang Hospital Department of Neurosurgery
김기정 ( Kim Ki-Jeong ) - Seoul National University College of Medicine Seoul National University Bundang Hospital Department of Neurosurgery

Abstract


Background: Surgery for spinal metastasis is rapidly increasing in frequency with procedures ranging from laminectomy to spondylectomy combined with stabilization. This study investigated the effect of various surgical procedures for spinal metastasis of non-small cell lung cancer (NSCLC).

Methods: A single-center consecutive series of patients who underwent surgery for spinal metastasis of NSCLC were retrospectively reviewed. Patients' characteristics, radiographic parameters, operative data, clinical outcomes, and complications were analyzed. Surgical outcomes were assessed according to pain and performance status before and after surgery. Overall survival (OS) rate was estimated using the Kaplan-Meier method. Multivariate analysis was performed to detect factors independently associated with OS using a Cox proportional hazards model.

Results: Twenty-one patients were treated with laminectomy, 24 with corpectomy, 13 with spondylectomy (piecemeal or total en bloc fashion), and all procedures were combined with stabilization. Back pain and performance status improved significantly after surgical treatment among the three groups. Revision surgery due to tumor progression at the index level or spinal metastasis at another level were four patients (19.0%) in the laminectomy group, six patients (25.0%) in the corpectomy group, and one patient (7.7%) in the spondylectomy group. A Charlson comorbidity index and the number of spinal metastasis negatively affected OS (hazard ratio [HR], 19.613 and 2.244). Postoperative chemotherapy, time to metastasis, spondylectomy, and corpectomy had favorable associations with OS (HR, 0.455, 0.487, 0.619, and 0.715, respectively).

Conclusion: Postoperative chemotherapy was the most critical factor in OS of patients with metastatic NSCLC to the spine. An extensive surgical procedure (corpectomy/spondylectomy) with stabilization also could be beneficial for limited patients with spinal metastasis of NSCLC.

키워드

Non-small Cell Lung Cancer; Spinal Metastasis; Laminectomy; Corpectomy; Spondylectomy; Overall Survival Rate

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