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
Small cell lung cancer (SCLC) is a lethal tumor accounting for approximately 15% of all lung cancers.1 Comparing with other types of lung cancer, SCLC is characterized by a more rapid doubling time, a higher growth fraction, and earlier development of widespread metastases,2 with around two-thirds of SCLC patients presenting with metastatic disease at diagnosis.3 Despite the chemosensitivity of SCLC, most patients relapse within a year after the initial treatment.4 Prognosis in SCLC is poor. Median survival time has been reported as 23 months for patients with limited-stage disease, 7–12 months for patients with extensive-stage disease, and only 2–4 months for patients without treatment.3,4 It is estimated that there were 250,000 cancer deaths caused by SCLC worldwide yearly, leading SCLC to be a worldwide serious public health problem.1
Bone metastasis was found in 27–41% of SCLC patients at initial presentation.5 Among patients with bone metastases of SCLC, 70.5% had spinal metastases.6 Spinal cord compression (SCC) is a disastrous complication of spinal metastatic tumor, leading to a substantial and striking change in quality of life (QoL) for patients.7,8 The role for surgical intervention for metastatic SCC is well established with the goal of pain relief, preservation of neurologic function, maintenance of spinal stability, and improving QoL.9,10 Our experience in surgical management of non-small cell lung cancer (NSCLC) spinal metastasis showed that complete disappearance of deficits in spinal cord function after surgery was the most robust favorable prognostic factor of survival,11 and surgical treatment significantly improved the QoL over the nine-month assessment period.12 However, little is known about spinal metastasis of SCLC, because there is a lack of studies due to small numbers of patients and their short survival times. The largest isolated cohort of this complicated disease was reported by Goldman et al in 1989.13 In their study, 24 cases of SCC caused by SCLC were identified from 610 cases of SCLC, and most of them were treated by radiotherapy. The authors emphasized the poor prognosis of this condition, and early prophylactic radiotherapy was also encouraged. Nevertheless, whether patients suffered from SCC caused by metastatic SCLC, such a highly malignant tumor with short life expectancy, benefit from spinal surgery remains unknown.
In this study, we retrospectively reviewed 30 consecutive patients with SCC from metastatic SCLC treated with urgent surgery over a period of 10 years, to provide some useful insight into clinical characteristics, surgical treatment, outcomes, and prognostic factors on this kind of challenging disease.
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