Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit St., White Building Room 502, Boston, MA 02114, USA.
J Clin Neurosci. 2011 Oct;18(10):1336-9. doi: 10.1016/j.jocn.2011.02.020. Epub 2011 Jul 22.
Metastatic vertebral body and spinal epidural lesions cause significant pain and neurological morbidity and negatively impact quality of life and survival. In instances of metastatic epidural spinal cord compression, treatment typically involves surgery and radiotherapy. The incidence of spinal metastases in breast cancer patients is high. In the light of recent improvements in survival among some patients with breast cancer, we reviewed the treatments and outcomes for patients with breast cancer who presented to our institution with metastatic epidural spinal cord compression. We identified all patients undergoing open surgery for the treatment of breast cancer metastases to the spine at our center from 1 January 2001 to 31 December 2009. We retrospectively reviewed records for the details of medical history, treatment, surgery, radiographic imaging, and follow-up. The Death Master File from the United States Social Security Administration was queried to identify the date of death where the medical record was incomplete. Outcomes were assessed by overall survival as well as preoperative and postoperative ambulatory status, bladder function, and the American Spinal Injury Association impairment classification system (ASIA). A total of 15 female patients were identified as having surgical intervention directly related to breast cancer metastasis to the spine. Most lesions (12/15) were located in the anterior vertebral column (vertebral body and/or pedicle). Two patients required re-operation, one for epidural fluid collection and one for infection. Roughly half of the patients (8/15) had well-controlled systemic disease at the time of surgery. Five patients had non-contiguous metastatic lesions elsewhere in the spine. Median survival following surgery was 1,025 days; control of systemic disease did not predict duration of postoperative survival. Seven patients had documented improvement in their ability to ambulate in the first 30 days following surgery. Bladder function was preserved in all. No patient deteriorated; and five patients had postoperative improvement of their ASIA impairment scale grade. We concluded that aggressive therapy, including surgery, is warranted for patients with symptomatic metastatic epidural spinal cord compression from breast cancer, including in the setting of advanced and progressive systemic disease.
转移性椎体和脊柱硬膜外病变可导致严重疼痛和神经功能障碍，并对生活质量和生存产生负面影响。在硬膜外脊髓压迫的转移性病变中，治疗通常包括手术和放疗。乳腺癌患者发生脊柱转移的几率较高。鉴于某些乳腺癌患者的生存情况最近有所改善，我们回顾了在我院就诊的患有转移性硬膜外脊髓压迫的乳腺癌患者的治疗方法和结果。我们确定了 2001 年 1 月 1 日至 2009 年 12 月 31 日期间在我院接受脊柱转移癌开放性手术治疗的所有乳腺癌患者。我们回顾性地查阅了病历，以了解病史、治疗、手术、影像学检查和随访的详细信息。美国社会保障管理局的死亡主文件被用来确定病历不完整的死亡日期。通过总体生存率以及术前和术后的步行能力、膀胱功能和美国脊柱损伤协会损伤分级系统（ASIA）来评估结果。共确定了 15 名女性患者，她们的手术干预与乳腺癌脊柱转移直接相关。大多数病变（12/15）位于前脊柱柱（椎体和/或椎弓根）。两名患者需要再次手术，一名因硬膜外积液，另一名因感染。大约一半的患者（8/15）在手术时患有控制良好的系统性疾病。5 名患者的脊柱其他部位有非连续转移病灶。手术后中位生存时间为 1025 天；手术时控制系统性疾病并不能预测术后生存时间。7 名患者在手术后 30 天内步行能力有记录改善。所有患者的膀胱功能均得到保留。没有患者病情恶化；5 名患者术后 ASIA 损伤分级有改善。我们的结论是，对于有症状的乳腺癌硬膜外脊髓压迫的患者，包括在晚期和进展性系统性疾病的情况下，积极的治疗方法，包括手术，是合理的。
