**Contents**



#### **Takashi Hirai, Masashi Uehara, Masayuki Miyagi, Shinji Takahashi and Hiroaki Nakashima** Current Advances in Spinal Diseases of the Elderly: Introduction to the Special Issue Reprintedfrom:*J.Clin.Med.***2021**,*10*,3298,doi:10.3390/jcm10153298................**237**

#### *Article* **The Effect of Adding Biological Factors to the Decision-Making Process for Spinal Metastasis of Non-Small Cell Lung Cancer**

**Hyoungmin Kim, Sam Yeol Chang \*, Jongyeon Son, Sujung Mok, Sung Cheol Park and Bong-Soon Chang**

Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 03080, Korea; hmkim21@gmail.com (H.K.); 2001jyson@hanmail.net (J.S.); charisma9025@naver.com (S.M.); neoz0708@gmail.com (S.C.P.); bschang@snu.ac.kr (B.-S.C.) **\***Correspondence:hewl3102@gmail.com;Tel.:+82-2-2072-7607

**Abstract:** Molecular target therapies have markedly improved the survival of non-small cell lung cancer (NSCLC) patients, especially those with epidermal growth factor receptor (EGFR) mutations. A positive EGFR mutation is even more critical when the chronicity of spinal metastasis is considered. However, most prognostic models that estimate the life expectancy of spinal metastasis patients do not include these biological factors. We retrospectively reviewed 85 consecutive NSCLC patients who underwent palliative surgical treatment for spinal metastases to evaluate the following: (1) the prognostic value of positive EGFR mutation and the chronicity of spinal metastasis, and (2) the clinical significance of adding these two factors to an existing prognostic model, namely the New England Spinal Metastasis Score (NESMS). Among 85 patients, 38 (44.7%) were EGFR mutationpositive. Spinal metastasis presented as the initial manifestation of malignancy in 58 (68.2%) patients. The multivariate Cox proportional hazard model showed that the chronicity of spinal metastasis (hazard ratio (HR) = 1.88, *p* = 0.015) and EGFR mutation positivity (HR = 2.10, *p* = 0.002) were significantly associated with postoperative survival. The Uno's C-index and time-dependent AUC 6 months following surgery significantly increased when these factors were added to NESMS (*p* = 0.004 and *p* = 0.022, respectively). In conclusion, biological factors provide an additional prognostic value for NSCLC patients with spinal metastasis.

**Keywords:** spinal metastasis; non-small cell lung cancer; decompression; survival; prognosis; epidermal growth factor receptor; Uno's C-index; New England Spinal Metastasis Score
