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

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.