The Effect of Adding Biological Factors to the Decision-Making Process for Spinal Metastasis of Non-Small Cell Lung Cancer

Abstract

Molecular target therapies have markedly improved the survival of non-small cell lung cancer (NSCLC) patients, especially those with epidermal growth factor receptor (EGFR) mutations. A positive EGFR mutation is even more critical when the chronicity of spinal metastasis is considered. However, most prognostic models that estimate the life expectancy of spinal metastasis patients do not include these biological factors. We retrospectively reviewed 85 consecutive NSCLC patients who underwent palliative surgical treatment for spinal metastases to evaluate the following: (1) the prognostic value of positive EGFR mutation and the chronicity of spinal metastasis, and (2) the clinical significance of adding these two factors to an existing prognostic model, namely the New England Spinal Metastasis Score (NESMS). Among 85 patients, 38 (44.7%) were EGFR mutation-positive. Spinal metastasis presented as the initial manifestation of malignancy in 58 (68.2%) patients. The multivariate Cox proportional hazard model showed that the chronicity of spinal metastasis (hazard ratio (HR) = 1.88, p = 0.015) and EGFR mutation positivity (HR = 2.10, p = 0.002) were significantly associated with postoperative survival. The Uno’s C-index and time-dependent AUC 6 months following surgery significantly increased when these factors were added to NESMS (p = 0.004 and p = 0.022, respectively). In conclusion, biological factors provide an additional prognostic value for NSCLC patients with spinal metastasis.

When Should Spinal Surgery Be Considered for Spinal Metastasis from Non-Small Cell Lung Cancer?—Propensity Score Matched Study between Surgery with Radiotherapy and Radiotherapy Alone

“…This finding is interesting because the mean Tokuhashi in included cohorts was 5.2 points, meaning that expected life expectancy was less than six months. It is consistent with a previous report that positive EGFR mutation provided longer postoperative survival for NSCLC patients undergoing palliative surgical treatment for spinal metastases (HR = 2.10, p = 0.002) [35]. Furthermore, Batista et al demonstrated that the median survival of patients treated with EGFR inhibitors was improved up to 18 months.…”

The Outcome of Molecularly Targeted Therapy after Surgical Treatment of Spinal Metastasis

“…A recent study demonstrated that local control of a spinal metastasis of renal cell carcinoma also improved with MTT [ 9 ]. Among patients with renal cell carcinoma, the combination of MTT and surgery for a bone metastasis significantly improved overall survival [ 8 , 15 , 16 ]. Our study further supported the existing data suggesting that MTT conferred significantly longer survival on patients who received the therapy than on those who did not.…”

“…In particular, the introduction of molecularly targeted therapy (MTT) has dramatically improved patients' prognoses [5][6][7]. Additionally, there exists a report indicating that individuals afflicted with spinal metastasis may achieve a more favorable prognosis if they are candidates for MTT as a form of treatment [8]. Patients with a spinal metastasis of renal cell carcinoma treated with radiotherapy and MTT showed a higher local progression-free rate than patients who did not receive MTT [9], suggesting that MTT improves not only life expectancy but also local control of spinal metastases.…”

An Updated Review on the Treatment Strategy for Spinal Metastasis from the Spine Surgeon’s Perspective

“…Examples of target mutations include epidermal growth factor receptor (EGFR) in nonsmall cell lung cancer, v-raf murine sarcoma viral oncogene homolog B1 in melanoma, and hormonal receptors in breast and prostate cancers. Recently, Kim et al [38] discovered that the addition of EGFR mutation positivity to the NESMS system improves its discrimination ability. Their results emphasize the importance of genetic profiles while establishing treatment strategies for spinal metastasis.…”