脊柱转移瘤手术治疗后的预后因素

IF 2.3 Q2 ORTHOPEDICS Asian Spine Journal Pub Date : 2024-06-01 Epub Date: 2024-05-20 DOI:10.31616/asj.2023.0376
Kazuhiro Murotani, Shunsuke Fujibayashi, Bungo Otsuki, Takayoshi Shimizu, Takashi Sono, Eijiro Onishi, Hiroaki Kimura, Yasuyuki Tamaki, Naoya Tsubouchi, Masato Ota, Ryosuke Tsutsumi, Tatsuya Ishibe, Shuichi Matsuda
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引用次数: 0

摘要

研究设计目的:本研究旨在探讨脊柱转移性肿瘤术后的生存率和预后因素:脊柱转移瘤手术后的预后因素仍存在争议:方法:进行了一项回顾性多中心研究。研究对象包括2010年至2020年期间在日本九家脊柱转诊中心接受脊柱转移手术的345名患者。每位患者的数据均从病历中提取。为了确定预测术后生存预后的因素,我们使用 Cox 比例危险模型进行了单变量分析:平均年龄为 65.9 岁。常见的原发性肿瘤为肺癌(72例)、前列腺癌(61例)和乳腺癌(39例),67.8%(234例)的患者为溶骨性病变。硬膜外脊髓压迫量表评分为2或3分的患者占79.0%(n=271)。弗兰克尔A级瘫痪占1.4%(n=5),73.3%(n=253)根据新的片桐评分被归类为中危或高危。6个月的总生存率为-71.0%,12个月的总生存率为57.4%,24个月的总生存率为43.3%。在单变量分析中,Frankel 分级 A(危险比 [HR],3.59;95% 置信区间 [CI],1.23-10.50;pConclusions:Frankel分级A或新版片桐评分中的中危或高危患者的生存率较低,因此应慎重考虑手术指征。术后应考虑化疗或放疗,以提高生存率。
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Prognostic Factors after Surgical Treatment for Spinal Metastases.

Study design: A retrospective multicenter case series was conducted.

Purpose: This study aimed to investigate survival and prognostic factors after surgery for a metastatic spinal tumor.

Overview of literature: Prognostic factors after spinal metastasis surgery remain controversial.

Methods: A retrospective multicenter study was conducted. The study participants included 345 patients who underwent surgery for spinal metastases from 2010 to 2020 at nine referral spine centers in Japan. Data for each patient were extracted from medical records. To identify the factors predicting survival prognosis after surgery, univariate analyses were performed using a Cox proportional hazards model.

Results: The mean age was 65.9 years. Common primary tumors were lung (n=72), prostate (n=61), and breast (n=39), and 67.8% (n=234) presented with osteolytic lesions. The epidural spinal cord compression scale score 2 or 3 was recognized in 79.0% (n=271). Frankel grade A paralysis accounted for 1.4% (n=5), and 73.3% (n=253) were categorized as intermediate or high risk according to the new Katagiri score. The overall survival rates were -71.0% at 6 months, 57.4% at 12, and 43.3% at 24. In the univariate analysis, Frankel grade A (hazard ratio [HR], 3.59; 95% confidence interval [CI], 1.23-10.50; p<0.05), intermediate risk (HR, 3.34; 95% CI, 2.10-5.32; p<0.01), and high risk (HR, 7.77; 95% CI, 4.72-12.8; p<0.01) in the new Katagiri score were significantly associated with poor survival. On the contrary, postoperative chemotherapy (HR, 0.23; 95% CI, 0.15-0.36; p<0.01), radiation therapy (HR, 0.43; 95% CI, 0.26-0.70; p<0.01), and both adjuvant therapy (HR, 0.21; 95% CI, 0.14-0.32; p<0.01) were suggested to improve survival.

Conclusions: Surgical indications for patients with Frankel grade A or intermediate or high risk in the new Katagiri score should be carefully considered because of poor survival. Chemotherapy or radiation therapy should be considered after surgery for better survival.

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来源期刊
Asian Spine Journal
Asian Spine Journal ORTHOPEDICS-
CiteScore
5.10
自引率
4.30%
发文量
108
审稿时长
24 weeks
期刊最新文献
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