bims-rebome 2025-11-09 papers

Cureus. 2025 Oct;17(10): e95808

Risk Stratification for the Prediction of Skeletal-Related Events in Patients With Bone Metastases From Non-small Cell Lung Cancer.

Yoshihiro Sakamoto, Eiji Nakata, Masanori Hamada, Yoshimi Katayama, Shinsuke Sugihara, Toshifumi Ozaki.

Skeletal-related events (SREs) frequently occur in patients with bone metastases from non-small cell lung cancer (NSCLC). This study aimed to identify risk factors for SREs in patients with NSCLC. Based on these factors, we also aimed to stratify patients into subgroups to facilitate the assessment of SRE risk. This retrospective analysis used medical records of 139 patients with NSCLC bone metastases who received treatment at our institution between 2011 and 2014. The incidence of SREs was assessed, and SRE-free survival was analyzed using the Kaplan-Meier method. Clinical information collected at registration was assessed to identify factors associated with the onset of SREs within six months. Univariate analysis was performed using Fisher's exact test, and multivariate analysis was performed using Cox regression. Of the 139 patients, 36 (26%) developed SREs after registration. The SRE-free survival rates were 80% and 64% at 6 and 12 months, respectively. The univariate and multivariate analyses revealed that the absence of epidermal growth factor receptor (EGFR) mutations or anaplastic lymphoma kinase (ALK) rearrangement (hazard ratio (HR): 4.51, 95% confidence interval (CI): 1.32-15.7, p = 0.017) and a lactate dehydrogenase (LDH) level ≥400 U/L (HR: 8.08, 95% CI: 1.78-36.6, p = 0.0067) were risk factors for SRE presentation within six months. Patients were classified into the following three subgroups: with EGFR mutation or ALK rearrangement and LDH level <400 U/L; without EGFR mutation or ALK rearrangement and LDH level <400 U/L; with/without EGFR mutation or ALK rearrangement and LDH level ≥400 U/L. The corresponding six-month SRE-free survival rates were 92%, 69%, and 34%, respectively, showing significant differences (p < 0.001). Close monitoring is recommended for patients with LDH levels ≥400 U/L in daily clinical practice, particularly with the help of the proficiency of orthopedic and radiological experts, to prevent complications such as pathological fractures and paraplegia.

Keywords: anaplastic lymphoma kinase; bone metastases; epidermal growth factor receptor-tyrosine kinase; lactate dehydrogenase; non-small cell lung cancer; skeletal related events

DOI: https://doi.org/10.7759/cureus.95808

Neurosurgery. 2025 Nov 06.

Association Between Nutritional Status and Survival in Patients Requiring Treatment for Spinal Metastases.

AO Spine Knowledge Forum Tumor

BACKGROUND AND OBJECTIVES: The Patient-Generated Subjective Global Assessment (PG-SGA) is a standardized tool for assessing malnutrition in patients with cancer. The primary aim of this study was to assess the impact of preoperative nutritional status as measured by PG-SGA on survival in patients requiring surgical intervention and/or radiotherapy for spinal metastases.
METHODS: Patients with spinal metastases who underwent surgery and/or radiation therapy for symptomatic spinal metastases were enrolled in the AO Spine Metastatic Tumor Research and Outcomes Network, a prospective international multicenter research registry, between September 2017 and August 2022. Using the PG-SGA, nutritional status was classified into 3 categories: A, well nourished; B, moderately malnourished; and C, severely malnourished.
RESULTS: A total of 589 patients met the inclusion criteria; 362 were classified as well nourished (61%), 159 were moderately malnourished (27%), and 68 were severely malnourished (12%). The median survival was 491 days, 328 days, and 117 days for well-nourished, moderately malnourished, and severely malnourished patients, respectively. In the multivariate analyses, severe malnourishment (HR 2.5 95% CI 1.4-4.3, P < .01) and an ECOG performance status of 3 or 4 (HR 2.7 95% CI 1.2-6.0) remained associated with significantly worse survival.
CONCLUSION: Malnutrition as measured by the PG-SGA demonstrated to be significantly and independently associated with postoperative survival. The PG-SGA is a simple and useful tool to identify spinal metastases patients at risk of early postoperative mortality, and inclusion in the preoperative evaluation of these patients should be considered.

Keywords: Nutritional status; Radiation therapy; Spinal metastases; Surgery; Survival

DOI: https://doi.org/10.1227/neu.0000000000003834

Medicine (Baltimore). 2025 Nov 07. 104(45): e45359

Factors associated with postoperative quality of life in patients with spinal metastases from lung cancer.

Yan Li, Fangzhi Liu, Zhongjun Liu, Xiaoguang Liu, Hua Zhou, Xiao Liu, Yanchao Tang, Panpan Hu, Feng Wei.

The management of spinal metastases presents a significant challenge for spine surgeons, especially in cases of lung cancer, which is associated with the poorest prognosis among primary cancer types. This study aimed to evaluate the postoperative quality of life of patients with symptomatic spinal metastases from lung cancer and identify clinical factors associated with improved outcomes regarding quality of life. This was a retrospective review of a prospectively maintained database from November 2009 to November 2020, including 128 patients who underwent surgery for symptomatic spinal metastases from lung cancer. The primary outcome was the change in Karnofsky Performance Status (KPS) at 1 week and 6 months post-operation. Patients were dichotomized into an "improvement" group (KPS increased) and a "non-improvement" group (KPS stable or decreased). Binary logistic regression was used to identify independent preoperative factors associated with KPS improvement. A total of 72 males and 56 females, with a mean age of 60 ± 10 years, were enrolled in the current study. Male sex was associated with improved quality of life in the short-term post-operation (odds ratio [OR] = 0.42, 95% confidence interval [CI] [0.716-0.962]). Conversely, the number of total bone metastatic sites was negatively associated with short-term improvements in quality of life (OR = 3.66, 95% CI [1.55-8.67]). Additionally, a higher number of total bone metastatic sites was linked to reduced long-term improvements in quality of life, with an OR of 1.94 and a 95% CI of [1.05-3.59]. The number of bone metastasis sites is closely associated with postoperative quality of life in patients with spinal metastases from lung cancer. Careful patient selection is crucial and has the potential to significantly enhance the quality of life for these vulnerable individuals with limited life expectancy.

Keywords: lung cancer; quality of life; spinal cord compression; spinal metastases

DOI: https://doi.org/10.1097/MD.0000000000045359