title: Surgical intervention for vertebral metastases may benefit lung cancer patients no less than other patients: a retrospective study.
abstract: BACKGROUND
  Spinal metastasis is considered to have a worse prognosis in lung cancer than in other cancers, but recent clinical studies report improved overall survival of lung cancer. We compared the postoperative prognoses of vertebral metastatic tumors from lung with other types of cancer.
  
  
  METHODS
  From 2011 to 2015, 31 Japanese patients (mean age 73 years, range 55-88 years; 19 males, 12 females) underwent surgery for spinal metastasis at our center. We observed patients retrospectively in March 2016, dividing them into groups by cancer type: lung (LK group, n = 10); prostate, breast, or thyroid (PB group, n = 12); and other (OT group, n = 9). We compared survival and revised Tokuhashi score, which provides a basis for choosing a treatment course. Neurologic status was graded before and after surgery using the Frankel system.
  
  
  RESULTS
  Mean follow-up was 16.5 months (range 1-62 months). Only seven of 31 patients (22.6%) were alive at final follow-up. Frankel grade significantly improved postoperatively only in the LK (P = 0.01) and PB (P = 0.048) groups. Revised Tokuhashi score differed across groups (P < 0.0001), and was significantly lower in the LK group than in the PB group (P = 0.00) and OT group (P = 0.02). Postoperative survival was significantly shorter in the LK group than in the PB group (P = 0.01) but did not differ between the LK and OT groups.
  
  
  CONCLUSIONS
  The revised Tokuhashi score may underestimate the survival of lung cancer patients, who may derive the same benefit from surgical intervention as those with vertebral metastasis from other cancer types.
authors.affiliation: Department of Orthopedic Surgery, Akita Kousei Medical Center, 1-1-1 Iijima, Nishifukuro, Akita, 011-0948, Japan. takakoba825@hotmail.com.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kobayashi
authors.affiliation: Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
authors.forename: Naohisa
authors.initials: N
authors.lastname: Miyakoshi
authors.affiliation: Department of Orthopedic Surgery, Akita Kousei Medical Center, 1-1-1 Iijima, Nishifukuro, Akita, 011-0948, Japan.
authors.forename: Toshiki
authors.initials: T
authors.lastname: Abe
authors.affiliation: Department of Orthopedic Surgery, Akita Kousei Medical Center, 1-1-1 Iijima, Nishifukuro, Akita, 011-0948, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Abe
authors.affiliation: Department of Orthopedic Surgery, Akita Kousei Medical Center, 1-1-1 Iijima, Nishifukuro, Akita, 011-0948, Japan.
authors.forename: Kazuma
authors.initials: K
authors.lastname: Kikuchi
authors.affiliation: Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Shimada
authors.affiliation: Department of Anesthesiology, Akita Kousei Medical Center, 1-1-1 Iijima, Nishifukuro, Akita, 011-0948, Japan.
authors.forename: Seiko
authors.initials: S
authors.lastname: Matsumoto
authors.affiliation: Department of Respiratory Medicine, Akita Kousei Medical Center, 1-1-1 Iijima, Nishifukuro, Akita, 011-0948, Japan.
authors.forename: Shin
authors.initials: S
authors.lastname: Fukui
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001416:Back Pain / Q000209:etiology / Q000473:pathology / Q000601:surgery; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000151:congenital / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000379:methods; D013125:Spinal Neoplasms / Q000150:complications / Q000556:secondary* / Q000601:surgery*
keywords: Lung cancer; Metastatic vertebral tumor; Prognosis; Revised Tokuhashi score; Survival period