title: Emerging and established clinical, histopathological and molecular parametric prognostic factors for metastatic spine disease secondary to lung cancer: Helping surgeons make decisions.
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.
authors.affiliation: 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.
authors.forename: Nuno
authors.initials: N
authors.lastname: Batista
authors.affiliation: 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.
authors.forename: Jin
authors.initials: J
authors.lastname: Tee
authors.affiliation: Department of Neurosurgery, John Hopkins University, Baltimore, MD, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Sciubba
authors.affiliation: Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON, Canada.
authors.forename: Arjun
authors.initials: A
authors.lastname: Sahgal
authors.affiliation: Department of Neurosurgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.
authors.forename: Ilya
authors.initials: I
authors.lastname: Laufer
authors.affiliation: Department of Orthopaedics, McGill University, Montreal, QC, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Weber
authors.affiliation: Department of Neurosurgery, John Hopkins University, Baltimore, MD, USA.
authors.forename: Ziya
authors.initials: Z
authors.lastname: Gokaslan
authors.affiliation: Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
authors.forename: Laurence
authors.initials: L
authors.lastname: Rhines
authors.affiliation: Neural Repair and Regeneration, Toronto Western Hospital, Toronto, ON, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Fehlings
authors.affiliation: Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
authors.forename: Shreyaskumar
authors.initials: S
authors.lastname: Patel
authors.affiliation: Division of Orthopaedic Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
authors.forename: Y
authors.initials: Y
authors.lastname: Raja Rampersaud
authors.affiliation: Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON, Canada.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Reynolds
authors.affiliation: Department of Neurological Surgery, UCSF, San Francisco, CA, USA.
authors.forename: Dean
authors.initials: D
authors.lastname: Chou
authors.affiliation: Department of Neurosurgery, John Hopkins University, Baltimore, MD, USA.
authors.forename: Chetan
authors.initials: C
authors.lastname: Bettegowda
authors.affiliation: Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Clarke
authors.affiliation: 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: Charles.Fisher@vch.ca.
authors.forename: Charles
authors.initials: C
authors.lastname: Fisher
mesh_terms: D000066491:Clinical Decision-Making; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology*; D013125:Spinal Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000556:secondary; D066231:Surgeons
keywords: ALK; Adjuvant therapy; EGFR; Genetic markers; Lung cancer; Metastatic spine disease