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| LIU Yancheng,MA Xin－long,HU Yongcheng.Epidemiological characteristics of lung cancer patients with spinal metastases[J].Chinese Journal of Spine and Spinal Cord,2021,(2):103-110. |
| Epidemiological characteristics of lung cancer patients with spinal metastases |
| Received:August 18, 2020 Revised:October 01, 2020 |
| English Keywords:Spinal Metastasis Lung cancer Epidemiology Scores systems Adenocarcinoma |
| Fund:北京医卫健康公益基金会项目（B20371FN） |
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| English Abstract: |
| 【Abstract】 Objectives: To study the epidemiological characteristics of spinal metastasis secondary to lung cancer in several nationwide medical centers. Methods: From March 2006 to September 2019, data of spinal metastases secondary to lung cancer in six Chinese medical centers were recorded. Using medical records, telephone follow-up, outpatient follow-up, to collect the patients′ gender, age, length of hospital stay, smoking history, tumor credits, transferring the segmental spinal and number, the other transfer situation, nerve function Frankel classification, KPS score, physical condition and whether surgery, radiotherapy, chemotherapy and targeted drug therapy． The age group was bounded by every 10 years. The pathologic types divided into small cell lung cancer(SCLC) and non-small cell lung cancer(NSCLC), NSCLC was further divided into adenocarcinoma, squamous cell carcinoma, adenosquamous cell carcinoma, large cell carcinoma and unclassified lung cancer. The relationship between age, sex and tumor subtypes, the level and frequency of spinal metastasis, the frequency of visceral metastasis, the relationship between neurological function and general condition, surgery and prognosis score were analyzed. Results: A total of 811 patients with lung cancer of spinal metastases were collected. Finally 541 cases with histological diagnosis were enrolled in this study including 313 males and 228 females. The mean age of male and female was 58.8±29.9(32-75) years old and 56.7±29.1(28-72) years old respectively. The morbidities of 50 to 69 years old and 60 to 69 years old were higher than other age groups which accounting for 36.04 percent and 36.41 percent, respectively. Histologic type of NSCLC was 499 cases(92.24%), SCLC was 28 cases(5.18%), others was 14 cases(2.59%). In NSCLC, 432 cases(79.85%) of adenocarcinoma, 47 cases(8.69%) of squamous cancer, 3 cases（0.55%） of adenosquamouscarcinoma, 1 case of large cell carcinoma(0.18%), 16 cases of unidentified NSCLC(2.96%). Compared between men and women, there was no significant difference in the morbidity of adenocarcinoma. However, the morbidities of small cell lung cancer and squamous carcinoma of male group were significantly higher than female group (P<0.05). 172 cases of patients with a history of smoking and 369 cases without, the incidence of squamous cancer was significantly different between the two groups(P<0.01). 53% cases of lung cancer and spinal metastasis were diagnosed simultaneously. Osseous metastasis: 199 cases affected spine alone, other 342 cases were concomitant with other bone metastases; Spine metastases: 156 cases involved one segment, 112 cases involved two segments, and 273 cases involved more than three segments. Frequency of spinal metastases: cervical spine in 105 cases(9%), thoracic spine in 287 cases(25%), thoracolumbar spine in 239 cases(20%), lumbar spine in 275 cases(24%), sacral spine in 258 cases(22%). Visceral metastases were identified in 184 cases(34%) with a total of 288 metastatic cites, which were intrapulmonary metastasis in 69 cases, 66 brain metastases, 62 liver and 39 adrenal glands metastases. Frankel spinal cord injury classifications: grade A in 12 cases, grade B in 9 cases, grade C in 31 cases, grade D in 180 cases, and grade E in 309 cases. KPS scores: 10 to 49 points in 26 cases, 50 to 79 points in 328 cases, 80 to 100 points in 187 cases. 217 cases underwent surgery including 198 open procedures and 19 cases of percutaneous vertebroplasty or kyphoplasty. 324 cases underwent non-invasive treatment(radiation, chemotherapy, targeted drug therapy). The mean Tokuhashi scores of patients underwent surgery or not was 5.96±2.02 and 5.65±1.96, respectively. No differences were found between the two groups(P<0.05). There were 21 cases who had surgical indications by Tokuhashi scores criteria of ≥9 points. However, 199 cases(91.71%) had surgical indications according to Uei scores of ≥3 points. Conclusions: The highest morbidities of lung cancer with spinal metastasis are between 50 to 69 years old. Adenocarcinoma is the most common histologic typ; thoracic and lumber spine is the highest affected location. Patient′s neurological status and physical condition are the most concern for surgery by orthopedic surgeons. |
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