Emerging and established clinical, histopathological and molecular parametric prognostic factors for metastatic spine disease secondary to lung cancer: Helping surgeons make decisions

Nuno Batista; Jin Tee; Daniel Sciubba; Arjun Sahgal; Ilya Laufer; Michael Weber; Ziya Gokaslan; Laurence Rhines; Michael Fehlings; Shreyaskumar Patel; Y Raja Rampersaud; Jeremy Reynolds; Dean Chou; Chetan Bettegowda; Michelle Clarke; Charles Fisher

doi:10.1016/j.jocn.2016.05.023

Emerging and established clinical, histopathological and molecular parametric prognostic factors for metastatic spine disease secondary to lung cancer: Helping surgeons make decisions

J Clin Neurosci. 2016 Dec:34:15-22. doi: 10.1016/j.jocn.2016.05.023. Epub 2016 Sep 12.

Authors

Affiliations

¹ Division of Spine, Department of Orthopaedics, University of British Columbia and Vancouver Coastal Health, 6th Floor Blusson Spinal Cord Centre, Vancouver, British Columbia V5Z 1M9, Canada.
² Department of Neurosurgery, John Hopkins University, Baltimore, MD, USA.
³ Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON, Canada.
⁴ Department of Neurosurgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.
⁵ Department of Orthopaedics, McGill University, Montreal, QC, Canada.
⁶ Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
⁷ Neural Repair and Regeneration, Toronto Western Hospital, Toronto, ON, Canada.
⁸ Division of Orthopaedic Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
⁹ Department of Neurological Surgery, UCSF, San Francisco, CA, USA.
¹⁰ Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA.
¹¹ Division of Spine, Department of Orthopaedics, University of British Columbia and Vancouver Coastal Health, 6th Floor Blusson Spinal Cord Centre, Vancouver, British Columbia V5Z 1M9, Canada. Electronic address: [email protected].

PMID: 27634496
DOI: 10.1016/j.jocn.2016.05.023

Abstract

Metastatic lung cancer to the spine occurs at high rates with patients usually given poor prognoses. Recent studies have observed that patients with certain genetic and molecular aberrations have better responses to adjuvant therapy. As such, current metastatic spine disease treatment algorithms grading all lung primaries' prognosis as poor may lead to inadequate treatment of spinal metastases. The aims of this study are to determine current survival patterns in metastatic spine disease secondary to lung cancer and identify relevant parameters that influence the prognostication of these patients. A systematic review in accordance with PRISMA guidelines was conducted for literature published between January 1, 1996 and September 31, 2015. The 27 studies identified were Level IV retrospective studies with an overall 'low' level of evidence. The overall median survival of patients with spine involved metastatic lung cancer was poor, ranging from 3.6 to 9months. Median survival of patients with non-small cell lung cancer being treated with epidermal growth factor receptor (EGFR) inhibitors were observed to be better, with survival of up to 18months. This review reports a subset of lung cancer patients with oncogenic molecular mutations that appear to confer a better overall survival. In these patients, individualized assessment rather than strict adherence to current metastatic scoring algorithms when determining management may be preferred.

Keywords: ALK; Adjuvant therapy; EGFR; Genetic markers; Lung cancer; Metastatic spine disease.

Publication types

Review
Systematic Review

MeSH terms

Clinical Decision-Making*
Humans
Lung Neoplasms / mortality
Lung Neoplasms / pathology*
Spinal Neoplasms / diagnosis*
Spinal Neoplasms / mortality
Spinal Neoplasms / secondary
Surgeons*