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Surgical Treatment of Spinal Cord Compression Caused by Metastatic Small Cell Lung Cancer: Ten Years of Experience in a Single Center

Authors Gao X, Zhang K, Cao S, Hou S, Wang T, Guo W, Wu Z, Jia Q, Liu T, Xiao J

Received 18 February 2020

Accepted for publication 5 May 2020

Published 19 May 2020 Volume 2020:12 Pages 3571—3578


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Antonella D'Anneo

Xin Gao,1,* Kun Zhang,1,* Shuang Cao,1,2,* Shuming Hou,1,* Tao Wang,1 Wen Guo,1,3 Zheyu Wu,1,4 Qi Jia,1 Tielong Liu,1 Jianru Xiao1

1Orthopaedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, People’s Republic of China; 2Department of Orthopedics, Third Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, People’s Republic of China; 3Department of Orthopedics, Taizhou People’s Hospital, Taizhou, Jiangsu Province, People’s Republic of China; 4Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Tielong Liu; Jianru Xiao
Orthopaedic Oncology Center, Department of Orthopaedics, Changzheng Hospital, No. 415 Fengyang Road, Huangpu District, Shanghai, People’s Republic of China
Tel +0086-021-81886843
Fax +0086-021-63520020

Purpose: Metastatic spinal cord compression (SCC) secondary to small cell lung cancer (SCLC) is a disastrous oncological emergency, but it is poorly understood due to the small numbers of patients and their short survival times. Whether patients suffered from SCC caused by metastatic SCLC benefit from spinal surgery remains unknown. The aim of this study was to evaluate the role of surgical treatment and prognostic factors in patients with SCC caused by metastatic SCLC.
Methods: From 2009 to 2019, 30 consecutive patients surgically treated for metastatic SCC from SCLC were enrolled in this retrospective analysis. Kaplan–Meier method and Cox regression analysis were used to estimate overall survival (OS) and identify prognostic factors. Quality of life (QoL) was assessed by the three-level EuroQol-five-Dimensions (EQ-5D-3L) instrument and compared using Student’s t test.
Results: The median OS time was 9 months in our series. Relief of pain, preservation of neurological function, and improvement of performance status were achieved after surgical intervention. The mean EQ-5D-3L utility score showed a significant improvement after surgery (0.3394 preoperatively vs 0.5884 postoperatively). According to Cox regression analysis, postoperative ECOG-PS and immunotherapy were identified to be independent prognostic factors for patients with SCC caused by metastatic SCLC.
Conclusion: Despite the short life expectancy, prompt surgical decompression is extremely necessary for patients with SCC caused by SCLC, for surgery played a critical role in improving patients’ QoL. Better performance status after surgery and receiving immunotherapy were associated with a longer OS.

Keywords: small cell lung cancer, spinal cord compression, surgery, quality of life, prognostic factor, immunotherapy

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