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Prognose nach operativem Wirbelsäuleneingriff bei Bronchialkarzinommetastasen

Prognosis after surgical treatment of spinal metastases due to lung cancer

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Zusammenfassung

Hintergrund

Zur Präzisierung der Prognose von Patienten mit vertebralen Bronchialkarzinommetastasen müssen lebensdauerbeeinflussende Parameter definiert werden. In dieser Arbeit wurden die Überlebenszeiten von Patienten nach operativem Wirbelsäuleneingriff in Abhängigkeit der Dauer der präoperativ bestehenden Grunderkrankung sowie der Biologie der Wirbelkörpermetastase untersucht.

Material und Methoden

Zwischen 01/1999 und 12/2003 wurden 68 Patienten im Traumatologischen Zentrum Hamburg St. Georg aufgrund vertebraler Bronchialkarzinommetastasen operiert. Anhand der Dokumentation in den Krankenakten wurden die genannten Zielgrößen evaluiert. Die Todeszeitpunkte des untersuchten Patientenguts entstammen dem Hamburger Krebsregister. Es erfolgte eine standardisierte Analyse der postoperativen Überlebenszeiten der Patienten in Abhängigkeit der ermittelten Zielgrößen.

Ergebnisse

Es handelte sich um 24 weibliche und 44 männliche Patienten in einem Durchschnittsalter von 62,6 Jahren. Von 65 Patienten waren die Todeszeitpunkte bekannt. Die durchschnittliche postoperative Überlebenszeit betrug bei Patienten mit zum Operationszeitpunkt unbekannter Grunderkrankung (n=20) 88 Tage, bei Patienten mit zum Operationszeitpunkt seit ≤12 Monaten bekannter Grunderkrankung (n=35) 141 Tage, bei Patienten mit zum Operationszeitpunkt seit >12 Monaten bekanntem Bronchialkarzinom (n=13) 170 Tage, bei Patienten mit nichtkleinzelligen Bronchialkarzinomen (n=45) 122 Tage, bei Patienten mit kleinzelligen Bronchialkarzinomen (n=20) 128 Tage und bei Patienten mit sonstigen Bronchialkarzinomen (n=3) 247 Tage.

Diskussion

Bei Patienten mit vertebralen Bronchialkarzinommetastasen, insbesondere bei denen mit primär unbekannter Grunderkrankung, sind aufgrund der ungünstigen Prognose nichtchirurgische Therapieansätze zu präferieren. Bezüglich der reduzierten Lebenserwartung sollte eine Sensibilisierung der Patienten selbst, aber auch der Angehörigen und des behandelnden Personals erfolgen.

Abstract

Background

Patients with spine metastaes due to lung cancer suffer from a reduced lifespan. For a more precise prognosis, it is important to define parameters which influence the individual survival time. This study reviewed the mean survival time of patients who had undergone surgery because of spine metastases due to lung cancer. It should be evaluated whether the postsurgical survival time is dependent on the length of time between diagnosis and surgery and from the histological type of the tumor.

Material and Methods

Between January 1999 and December 2003, 68 patients had undergone spine surgery because of spine metastases due to lung cancer at the department of traumatology of the St. Georg General Hospital in Hamburg, Germany. Retrospective data were collected from the hospital documentary system regarding the period between diagnosis of lung cancer and date of surgical treatment, and regarding the histological type of the tumor. The postsurgical survival times were evaluated using data from the Hamburger Cancer Index and from general practitioners. These times were analysed afterward according to the defined parameters.

Results

The average age was 62.6 years, and 24 female and 44 male patients were included. It was possible to evaluate the survival time of 65 Patients. The average survival time of those with preoperative unknown primary manifestation (20 Patients) was 88 days, in the group of patients with lung cancer histories of less than 12 months (35 Patients) 141 days, and with patients with lung cancer histories of lung cancer longer than 12 months (13 Patients) it was 171 days. The mean survival times after surgical treatment were 122 days for patients suffering from non-small-cell lung cancer (45 Patients), 128 days for those with small-cell lung cancer (20 Patients), and 247 days for patients with other histological types (three patients).

Discussion

The prognosis of patients after spine surgery for lung cancer metastases is poor. The indication for surgical treatment of spinal metastases due to lung cancer should be critically discussed. Especially patients with unknown primary manifestation might benefit from a conservative approach. With respect to the patients’ reduced lifespan, they, their relatives, and the nursing staff should be carefully informed.

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Authors and Affiliations

  1. Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland

    C. Hessler, J. Regelsberger, F. Raimund & O. Heese

  2. Chirurgisch-Traumatologische Klinik, Allgemeines Krankenhaus St. Georg, Hamburg, Deutschland

    J. Madert & C. Eggers

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  1. C. Hessler
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  2. J. Regelsberger
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Correspondence to C. Hessler.

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Hessler, C., Regelsberger, J., Raimund, F. et al. Prognose nach operativem Wirbelsäuleneingriff bei Bronchialkarzinommetastasen. Chirurg 79, 671–679 (2008). https://doi.org/10.1007/s00104-008-1541-7

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