Department of Neurosurgery, Istituto Clinico Humanitas, Rozzano, Italy.
Eur Spine J. 2012 May;21 Suppl 1(Suppl 1):S146-8. doi: 10.1007/s00586-012-2232-0. Epub 2012 Mar 10.
To identify potential prognostic factors predicting functional outcome and survival after surgery followed by radiotherapy for metastatic spinal cord compression due to solid tumors.
531 consecutive patients with metastatic epidural spinal cord compression (MESCC) were treated at our institution. Surgery followed by radiation therapy was performed in 151 patients (30%) with various histological diagnoses. Three different surgical procedures were performed: minimal resection with or without instrumented fixation, curettage, and total tumorectomy. Within 1 month after surgery, RT was performed, delivering a total dose of 30-36 Gy (3 Gy per fraction). Ten potential prognostic factors were investigated for relationship with functional outcome and survival.
Clinical remission of pain was obtained in 91% of patients and 94 (62.5%) had recovery of neurological deficit. Recurrence in the same site of treatment occurred in nine (6%) patients. Median survival was 14 months (range 0-52 months); OS at 1, 2, and 3 years was 43.6, 37, and 21.5%, respectively. Survival was significantly associated with the histology of primary tumor (P < 0.001) and visceral metastases (P < 0.001) in the whole group; for histology, the prognostic factors statistically significant were other bone metastases in breast cancer, control of primary tumor, and the absence of visceral metastases in NSCLC and kind of surgery in the other.
The key element for successful treatment of MESCC is multidisciplinary care of the patient, which includes all of those prognostic factors that have been, until now, analyzed and compared. In our set of patients treated for vertebral metastases, PS, time to development of symptoms, and the presence of visceral metastases affected functional outcome and survival.
确定预测实体瘤转移性脊柱脊髓压迫症（MESCC）患者手术后接受放疗后功能结局和生存的潜在预后因素。
本机构共治疗了 531 例转移性硬膜外脊髓压迫（MESCC）患者。151 例（30%）患者接受了各种组织学诊断的手术联合放疗。进行了三种不同的手术：最小切除伴或不伴器械固定、刮除和全肿瘤切除术。术后 1 个月内进行放疗，总剂量 30-36Gy（3Gy/次）。研究了 10 个潜在的预后因素与功能结局和生存的关系。
91%的患者疼痛缓解，94 例（62.5%）患者神经功能缺损恢复。9 例（6%）患者在同一治疗部位复发。中位生存时间为 14 个月（0-52 个月）；1、2、3 年 OS 分别为 43.6%、37%和 21.5%。总生存与肿瘤原发灶的组织学（P<0.001）和内脏转移（P<0.001）显著相关；在组织学方面，具有统计学意义的预后因素为乳腺癌的其他骨转移、原发灶控制和非小细胞肺癌无内脏转移以及其他手术方式。
成功治疗 MESCC 的关键要素是患者的多学科护理，包括迄今为止分析和比较过的所有预后因素。在我们治疗脊柱转移的患者中，PS、症状出现时间和内脏转移的存在影响了功能结局和生存。
