Beyond the Scalpel: EGFR Mutation Predicts Intraoperative Blood Loss and Transfusion Needs During Lung Cancer-derived Spinal Metastasis Surgery.

Abstract

Surgical intervention for lung cancer-derived spinal metastasis (LCSM) is frequently associated with significant intraoperative hemorrhage. This prospective cohort study aimed to identify clinical predictors of intraoperative blood loss (IOBL) and red blood cell transfusion requirements in patients undergoing LCSM surgery. Consecutive patients treated surgically for LCSM at a tertiary medical center between January 2017 and August 2024 were prospectively enrolled. Demographic, surgical, and laboratory variables were evaluated, including epidermal growth factor receptor (EGFR) mutation status, metastatic burden, and coagulation profiles. Multivariable linear regression models were used to quantify associations with IOBL and transfusion volume. Among 163 patients, mean IOBL was 765 ± 890 mL, with 54.6% requiring red blood cell transfusions (mean 4.9 ± 2.9 units). Transfused patients demonstrated 3.8-fold greater blood loss than their non-transfused counterparts (1151.7 vs 300.9 mL, p < 0.001). Key independent predictors of IOBL included EGFR mutation (β = 309.7 mL, p = 0.012), lumbar metastases (β = 288.7 mL, p = 0.038), surgical duration (168.7 mL/h, p < 0.001), laminectomy levels (284.3 mL/level, p < 0.001), and elevated preoperative international normalized ratio (β = 1156.9 mL, p = 0.018). Predictors of transfusion volume paralleled these findings, with EGFR mutation (β = 1.33 units, p = 0.002) and laminectomy levels (β = 0.75 units/level, p = 0.003) demonstrating dose-dependent relationships. This study identified EGFR mutation as a novel molecular predictor of hemorrhagic risk in LCSM surgery, independent of systemic therapy status. The quantifiable impact of procedural complexity and coagulation dysfunction provides actionable thresholds for preoperative optimization. These findings enable stratified blood management protocols, particularly for EGFR-mutated cohorts requiring multilevel decompression.