Factors affecting clinical follow-up of patients who had extended resection due to non-small cell lung cancer with vertebral invasion

• Published in: Current thoracic surgery Vol. 9; no. 1; p. 13
• Main Authors: Şanlı, Bahar Ağaoğlu, Ulugün, Fatma İlknur, Mutlu, Fatma, Dinçtürk, Üstün Andaç, Karaçam, Volkan, Akçalı, Ömer, Şanlı, Aydın
• Format: Journal Article
• Language: English
• Published: 2024
• ISSN: 2548-0316; 2548-0316
• DOI: 10.26663/cts.2024.003

Background: Chest wall involvement or vertebral invasion can be detected in 8-15% of patients with nonsmall
cell lung cancer. We aimed to evaluate the surgical treatment outcomes and factors affecting overall
survival (OS) in those patients who underwent en-bloc resection due to vertebral and chest wall invasion.
Materials and Methods: The study encompassed 15 patients with locally advanced non-small cell
lung cancer who underwent anatomical lung resection and various vertebral and/or chest wall resections
because of vertebral invasion at our institution between 2007 and 2019. Demographic, clinical, and
pathological data of these patients were collected retrospectively and the effects of these factors on
surgical outcomes and survival were evaluated.
Results: The mean age of the 15 patients was 59.1 ± 10.2 years. Among the patients, six had adenocarcinoma
(40%), five had squamous cell carcinoma (33.3%), one had large cell neuroendocrine carcinoma (6.7%),
two had a combination of large cell neuroendocrine and adenocarcinoma (13.3%), and one had pleomorphic
cell carcinoma (6.7%). Simultaneous to lung resection, hemicorpectomy in four patients (26.6%), total
vertebrectomy in one patient (6.6%), partial corpectomy in three patients (20.0%), en-bloc transversectomy
in five patients (33.3%), hemilaminectomy in two patients (13.3%) were performed. Two patients underwent
only vertebra resection, while 13 patients underwent partial rib resection along with the vertebra. The median
overall survival (OS) was 26.3 months (14.7-37.8). The postoperative survival rates were 93%, and 33% for
30-day, and 3-year respectively. When comparing OS among histopathological subgroups, no statistically
significant difference was observed (p = 0.473). The median OS was 9.2 months for patients who underwent
only vertebra resection, while it was 26.3 months for those who underwent vertebra and rib resection (p =
0.534). Other clinical features such as neoadjuvant treatment status, surgical margin positivity, and presence
of recurrence did not exhibit a statistically significant impact on the patients' survival.
Conclusions: En-bloc resection is a treatment alternative that can be successfully applied in patients with
primary lung malignancies together with vertebral invasion. Nonetheless, chemotherapy, radiotherapy,
or immunotherapy is advised for disease management during the postoperative period.