Department of Surgical and Perioperative Sciences (Orthopedics), Umeå University, Umeå, Sweden.
Spine (Phila Pa 1976). 2012 Dec 15;37(26):2168-76. doi: 10.1097/BRS.0b013e31826011bc.
We retrospectively analyzed prognostic factors for survival in patients with prostate cancer operated for metastatic spinal cord compression.
The aim was to obtain a clinical score for prediction of survival after surgery.
Survival prognosis is important when deciding about treatment of patients with metastatic spinal cord compression. The criteria for identifying patients with prostate cancer who may benefit from surgical treatment are unclear.
The study comprised 68 consecutive patients with prostate cancer operated for metastatic spinal cord compression at Umeå University Hospital, Sweden. The indication for surgery was neurological deficit; 53 patients had hormone-refractory prostate cancer and 15 patients had previously untreated, hormone-naïve prostate cancer. In 42 patients, posterior decompression was performed and 26 patients were operated with posterior decompression and stabilization.
A new score for prediction of survival was developed on the basis of the results of survival analyses. The score includes hormone status of prostate cancer, Karnofsky performance status, evidence of visceral metastasis, and preoperative serum prostate-specific antigen (PSA). The total scores ranged from 0 to 6. Three prognostic groups were formulated: group A (n = 32) with scores 0-1; group B (n = 23) with scores 2-4, and group C (n = 12) with scores 5-6. The median overall survival was 3 (0.3-20) months in group A, 16 (1.8-59) months in group B, and more than half (7 of 12) of patients were still alive in group C.
We present a new prognostic score for predicting survival of patients with prostate cancer after surgery for metastatic spinal cord compression. The score is easy to apply in clinical practice and may be used as additional support when making decision about treatment.
我们回顾性分析了前列腺癌转移性脊髓压迫患者的生存预后因素。
旨在获得用于预测手术后生存的临床评分。
在决定转移性脊髓压迫患者的治疗方法时，生存预后很重要。目前尚不清楚用于确定哪些前列腺癌患者可能受益于手术治疗的标准。
本研究纳入了在瑞典于默奥大学医院接受手术治疗的 68 例前列腺癌转移性脊髓压迫患者。手术指征为神经功能缺损；53 例患者为激素难治性前列腺癌，15 例患者为未经治疗的激素初治前列腺癌。42 例患者接受后路减压，26 例患者接受后路减压和稳定术。
基于生存分析结果，制定了用于预测生存的新评分。该评分包括前列腺癌的激素状态、卡诺夫斯基表现状态、内脏转移证据和术前血清前列腺特异性抗原（PSA）。总评分范围为 0-6 分。形成了 3 个预后组：A 组（n=32）评分 0-1 分；B 组（n=23）评分 2-4 分；C 组（n=12）评分 5-6 分。A 组的中位总生存期为 3（0.3-20）个月，B 组为 16（1.8-59）个月，C 组中有 7 例（7/12）患者仍存活。
我们提出了一种新的预测前列腺癌患者在接受转移性脊髓压迫手术后生存的预后评分。该评分易于在临床实践中应用，可作为治疗决策的附加支持。
