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

The prognostic utility of neutrophil-lymphocyte ratio in spinal surgery: A systematic review and meta-analysis

PURPOSE

Neutrophil-lymphocyte ratio (NLR) is reportedly an effective prognostic tool across various medical and surgical fields, but its value in spinal surgery is unestablished. We aim to investigate the relationship between elevated baseline/postoperative NLR and patient outcomes in spinal surgery.

MATERIALS AND METHODS

We performed a systematic search in PubMed, EMBASE, and SCOPUS databases for studies investigating the prognostic value of NLR in spine patients.Odds ratios (ORs) and hazard ratios (HRs) with 95% confidence intervals (CIs) were analysed on the RevMan 5.4 software. Where meta-analysis was not possible, we vote-counted the direction of the effect of elevated NLR. The GRADE framework for prognostic factor research was utilised to assess the certainty of the evidence for each outcome measure.

RESULTS

Five outcome measures (overall survival, mortality, disease-free survival, functional recovery and complications) were assessed across 16 studies involving 5471 patients. Elevated baseline NLR was associated with reduced overall survival (HR: 1.63, 95 % CI: 1.05 - 2.54) (GRADE: low) and worsened functional recovery (OR: 0.93, 95 % CI: 0.87 - 0.98) (GRADE: low). There was no association between baseline NLR and disease-free survival (HR: 2.42, 95 % CI: 0.49 - 11.83) (GRADE: very low) or mortality (OR: 1.39, 95 % CI: 0.41 - 4.75) (GRADE: very low). Elevated NLR levels measured on days 3-4 and days 6-7 postoperatively, but not NLR measured at baseline or on days 1-2 postoperatively, were associated with greater risks of complications (GRADE: low).

CONCLUSIONS

NLR is an objective tool with the potential to identify the patients that would benefit from surgery and facilitate shared decision-making.

Prognostic Analysis of Spinal Metastasis Secondary to Lung Cancer after Surgeries: A Unicentric, Large-Cohort, Retrospective Study

PURPOSE

Spinal metastases of lung cancer (SMLC) usually have high degree of malignancy and require surgical treatment. However, there are several controversies about the efficacy of surgery. This study aimed to investigate factors predicting prognosis of SMLC after surgery-based comprehensive treatment.

METHODS

A cohort of 112 cases of SMLC who underwent surgical treatment between 2009 and 2020 were retrospectively reviewed and analyzed. The surgical strategies included total en-bloc spondylectomy, debulking surgery, palliative decompression, and vertebral augmentation procedures. The patients were regularly followed-up. Survival analysis was performed, as well as analysis of the patients' neurological recovery, pain relief, and improvement of Karnosky performance score (KPS). Cox regression was used to analyze influencing factors of survival time, and Kaplan-Meier method was performed in survival analysis.

RESULTS

The cohort included 63 males and 49 females, with an average age of 60.6 ± 10.6 years. Median survival time was 16 months. A total of 86.7% of paralysis patients' neurological function recovered and 83.9% of patients with low KPS score (10-40) improved. Surgical method was significantly correlated with improvement of neurological function (p < 0.001) and KPS (p < 0.001). The mean bleeding volume was 502 ml and operative time was 170 min. The survival rates at 3, 6, 12, 24, and 36 months were 92.0%, 80.4%, 63.4%, 63.4%, and 22.6%, respectively. Postoperative Frankel grade (p < 0.001), postoperative KPS score (p = 0.001), and application of molecular targeted drugs (p < 0.001) were significantly correlated with survival time in univariate analysis, while application of molecular targeted drugs was an independent predictor for a longer survival by a multivariate analysis.

CONCLUSION

Surgery-based comprehensive treatment brought a fair outcome, with elongated survival time. Surgery can significantly improve patients' neurological function and physical performance status. Adjuvant targeted therapy is an independent positive factor for patients' survival.

The effects of combined microwave ablation and open surgery for the treatment of lung cancer-derived thoracolumbar metastases

OBJECTIVE

To investigate the clinical effects of microwave ablation (MWA) in addition to open surgery for the treatment of lung cancer-derived thoracolumbar metastases.

METHODS

This was a single-institution, retrospective, cohort study. From January 2019 to December 2020, a total of 47 patients with lung cancer-derived thoracolumbar metastases underwent posterior spinal canal decompression and fixation surgery in our hospital. Two independent surgical teams treated these patients. One group underwent open surgery combined with MWA therapy, while the other had open surgery only (control). The pre- and post-operative visual analog scale (VAS) scores and the overall survival (OS) were compared between the MWA and control groups. The Frankel Grade classification was applied for the evaluation of the post-surgical spinal cord function. Improvement was defined as an increase of at least one rank from the pre-operative scores. Each patient was evaluated pre- and post-operatively at 48 h, 1 month, and 3-month intervals. Data on surgical-related complications were recorded.

RESULTS

Thirty men and 17 women were included, with an average age of 57.9 ± 11.4 years (range, 26-81 years). Twenty-eight patients underwent MWA and were in the MWA group, and 19 patients were included in the control group. Post-operatively all patients were followed up regularly; the median follow-up time was 12 months (range, 3-24 months), and their median OS was 14 months. Patients in the MWA group had a lower VAS score than those in the control group at the 48-h (1.75 ± 1.01 vs 2.47 ± 0.96, P = 0.01) and 1-month (1.79 ± 0.92 vs 2.53 ± 1.35, P = 0.048) check-ups. At the 3-month evaluation, the VAS score differences between the two groups were not significant (P = 0.133). After surgery, spinal cord function improvement was not significantly different between the MWA and control groups (P = 0.515). MWA therapy combined with open surgery was not associated with increased OS compared with the control group (P = 0.492).

CONCLUSION

MWA can be an effective and safe pain-relief method but may not extend the OS of patients with lung cancer.