Surgical Intervention for Vertebral Metastases May Benefit Lung Cancer Patients No Less Than Other Patients

A Retrospective Study

Takashi Kobayashi; Naohisa Miyakoshi; Toshiki Abe; Eiji Abe; Kazuma Kikuchi; Yoichi Shimada; Seiko Matsumoto; Shin Fukui

Disclosures

J Med Case Reports. 2017;11(4) 

In This Article

Discussion

The prognostic factors associated with spinal metastases are unclear. Surgery can improve mechanical stability, cord compression, and pain, and may be considered when a patient has a life expectancy of >3 months.[5,6] Palliative surgery for spinal metastasis can improve the quality and length of life.[23] The revised Tokuhashi score is an important and effective tool for considering the prognosis of patients with a metastatic vertebral tumor.[10–18] Spinal metastases are considered to carry a worse prognosis in patients with lung cancer compared with other cancers;[7–9,19] therefore, conservative treatment is selected for many lung cancer patients. However, improvements in chemotherapy, radiotherapy, and hormonal therapies have led to increased survival times for patients with lung cancer.[2,20]

Our results show that the postoperative survival period after surgical treatment of vertebral metastases was significantly shorter in the LK group than in the PB group, but did not differ between the LK and OT groups, even though the revised Tokuhashi score of the LK group was significantly lower than that of the PB and OT groups.

The present study highlights two important clinical issues. First, some cases of vertebral metastasis from lung cancer can be expected to have a long survival period. Patients with a revised Tokuhashi score of 0–8 are expected to survive <3 months. In the revised Tokuhashi scoring system, lung cancer is assigned 0 points, giving a low score to a lung cancer patient with Frankel C palsy. However, a lack of correlation between the revised Tokuhashi score and the survival period has been reported for patients with spinal metastases of lung cancer.[24–26] Ogihara et al. recommended surgical treatment of spinal metastases from lung cancer for patients without hypercalcemia or hypoalbuminemia.[24] Bilsky et al. showed that, when considering surgical intervention, patient-by-patient assessment may be more important than the result of a scoring instrument such as the Tokuhashi score.[27]

Second, the present study demonstrates that, when considering treatment of vertebral metastasis of lung cancer, surgical treatment may be appropriate even if the revised Tokuhashi score is <8 points. Chemotherapy, radiotherapy, and surgery are three treatment options for spinal metastases; of these, surgery is most effective for early mobilization and return to functional ambulation, but it is also the most invasive treatment and risks complications such as infection and worsening of palsy. However, only one of the 11 lung cancer patients in the present study had a severe postoperative complication; that patient (patient #7, Table 2) died from a surgical site infection 1 month after surgery. Despite the fears surrounding the invasiveness of surgery and its associated risks, we had a low rate of surgical complication. Hirabayashi et al. showed that postoperative ambulation was associated with a longer survival time after surgery for spinal metastases in patients with lung cancer.[23] Surgical treatment for a vertebral tumor from lung cancer can improve the quality of life and survival time.[28] Therefore, considering the advances made in lung cancer treatment and the results of the present study, we believe that the revised Tokuhashi score requires further revision, and that a primary cancer site score of 0 for lung cancer may no longer be justified. Because the average score for the primary cancer site in the OT group was 2.4, we believe that a score of 2 for lung cancer may be appropriate.

The limitations of the present study were its relatively small number of patients, the heterogeneity of the OT group, and the questionable validity of comparing the LK and OT groups.

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....