Spine-specific skeletal related events and mortality in non-small cell lung cancer patients: a single-institution analysis
Spine-specific skeletal related events and mortality in non-small cell lung cancer patients: a single-institution analysis
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DOI：
10.3171/2020.7.spine20829
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发表时间：
2022-01-01
影响因子：
2.8
通讯作者：
Jennings, Jack W.
中科院分区：
文献类型：
--
作者：
Adogwa, Owoicho;Rubio, Daniel R.;Jennings, Jack W.
目的 非小细胞肺癌（NSCLC）的人群患病率持续增加；然而，关于骨骼相关事件（SRE）（即脊柱手术、脊柱放射、射频消融、椎体后凸成形术/椎体成形术、脊髓压迫或病理性椎体骨折）的发生率及其对总体死亡率的影响的数据有限。在这项研究中，作者试图估计 NSCLC 患者 SRE 的发生率，并量化其对总体死亡率的影响。方法 这是一项对 2002 年至 2014 年间诊断为 NSCLC 的患者进行的单机构回顾性研究。计算了自肺癌诊断以来各时间段骨转移和随后的 SRE 的发生率（每 1000 人年），并对每种组织学类型分别进行分层分析。还计算了诊断后 1 年、2 年和 3 年的死亡率发生率，按 SRE 的存在情况进行分层。构建 Kaplan-Meier 生存曲线来描述有脊柱转移和 SRE 的患者以及有脊柱转移但无 SRE 的患者的粗生存率。这些曲线用于估计每个队列的 1 年和 2 年生存率。结果 我们确定了 320 名突发 NSCLC 患者（中位随访时间 9.5 个月）。平均 +/- SD 年龄为 60.65 +/- 11.26 岁； 94.48%的患者为吸烟者，60.12%有癌症家族史。大多数首次 SRE 是病理性椎体压缩骨折 (77.00%)，其次是放射治疗 (35%)、手术治疗 (14%) 和脊髓压迫治疗 (13.04%)。至少有 1 次 SRE 的脊柱转移非小细胞肺癌患者死亡率最高。按组织学亚型分层，大细胞队列中SRE患者的死亡率最高，为7.42/1000人年（95% CI 3.09-17.84/1000人年）；其次是鳞状细胞队列，每 1000 人年 2.49 个（95% CI 1.87-3.32 每 1000 人年）；腺癌队列中最低，为每 1000 人年 1.68（95% CI 为每 1000 人年 1.46-1.94）。 6% 的患者需要进行神经结构减压和脊柱稳定手术。结论 骨转移 NSCLC 患者的 SRE 与死亡率增加相关。
OBJECTIVE The population prevalence of non-small cell lung cancer (NSCLC) continues to increase; however, data are limited regarding the incidence rate of skeletal related events (SREs) (i.e., surgery to the spinal column, radiation to the spinal column, radiofrequency ablation, kyphoplasty/vertebroplasty, spinal cord compression, or pathological vertebral body fractures) and their impact on overall mortality. In this study, the authors sought to estimate the incidence rates of SREs in NSCLC patients and to quantify their impact on overall mortality. METHODS This was a single-institution retrospective study of patients diagnosed with NSCLC between 2002 and 2014. The incidence rates for bone metastasis and subsequent SREs (per 1000 person-years) by time since lung cancer diagnosis were calculated and analyses were stratified separately for each histological type. Incidence rates for mortality at 1, 2, and 3 years from diagnosis stratified by the presence of SREs were also calculated. Kaplan-Meier survival curves were constructed to describe crude survival ratios in patients with spine metastasis and SREs and those with spine metastasis but without SREs. These curves were used to estimate the 1- and 2-year survival rates for each cohort. RESULTS We identified 320 patients with incident NSCLC (median follow-up 9.5 months). The mean +/- SD age was 60.65 +/- 11.26 years; 94.48% of patients were smokers and 60.12% had a family history of cancer. The majority of firsttime SREs were pathological vertebral body compression fractures (77.00%), followed by radiation (35%), surgery (14%), and spinal cord compression (13.04%). Mortality rates were highest in NSCLC patients with spine metastasis who had at least 1 SRE. Stratifying by histological subtype, the incidence rate of mortality in patients with SRE was highest in the large cell cohort, 7.42 per 1000 person-years (95% CI 3.09-17.84 per 1000 person-years); followed by the squamous cell cohort, 2.49 per 1000 person-years (95% CI 1.87-3.32 per 1000 person-years); and lowest in the adenocarcinoma cohort, 1.68 per 1000 person-years (95% CI 1.46-1.94 per 1000 person-years). Surgery for decompression of neural structures and stabilization of the spinal column was required in 6% of patients. CONCLUSIONS SREs in NSCLC patients with bone metastasis are associated with an increased incidence rate of mortality.