Cheville Andrea L, Murthy Naveen S, Basford Jeffrey R, Rose Peter S, Tran Kenny, Pittelkow Thomas P, Ringler Michael D
Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN.
Department of Radiology, Mayo Clinic, Rochester, MN.
Arch Phys Med Rehabil. 2016 Jan;97(1):53-60. doi: 10.1016/j.apmr.2015.09.011. Epub 2015 Oct 3.
To distinguish which patients with bone metastases are at risk for near-term disablement in order to assist clinicians in assessing the appropriateness of referrals for rehabilitation services.
Prospective cohort study.
National Cancer Institute-designated comprehensive cancer center imbedded in a tertiary medical center.
Data were collected from members (n=78) of a patient cohort (N=311) with stage IIIB or IV non-small-cell lung cancer or extensive-stage small-cell lung cancer who developed new or progressive imaging-confirmed bone metastases during the 2-year course of the study.
Not applicable.
Functional capabilities were assessed at 3- to 4-week intervals over the study's 2-year duration with the Activity Measure for Post-Acute Care Computer Adaptive Testing.
Seventy-eight participants developed new or progressive bone metastases during the study. Most were men, and 83% had non-small-cell lung cancer. Metastases were most frequently located in the ribs (n=62), pelvis (n=49), or the thoracic (n=60) and lumbar spine (n=44). While neither the number of bone metastases nor their specific location was associated with near-term changes in patient mobility, their association with pain or a focal neurologic deficit was strongly associated with large declines in mobility. Similarly, patients whose imaging studies revealed new metastases and the expansion of established metastases were more likely to lose mobility.
The total burden, specific locations, and overall distribution of bone metastases did not predict disablement. Patients with lung cancer-associated bone metastases are at markedly increased risk for declining mobility when their metastases are expanding in size and increasing in number, or are associated with pain or with new neurologic deficits.
鉴别哪些骨转移患者存在近期失能风险，以协助临床医生评估康复服务转诊的适宜性。
前瞻性队列研究。
一所附属于三级医疗中心的美国国立癌症研究所指定的综合癌症中心。
数据收集自一组患者队列（N = 311）中的成员（n = 78），这些患者患有IIIB期或IV期非小细胞肺癌或广泛期小细胞肺癌，在研究的2年过程中出现了新的或进展性的经影像学证实的骨转移。
不适用。
在研究的2年期间，每隔3至4周使用急性后期护理计算机自适应测试活动量表评估功能能力。
78名参与者在研究期间出现了新的或进展性的骨转移。大多数为男性，83%患有非小细胞肺癌。转移最常发生在肋骨（n = 62）、骨盆（n = 49）或胸椎（n = 60）和腰椎（n = 44）。虽然骨转移的数量及其具体位置均与患者活动能力的近期变化无关，但它们与疼痛或局灶性神经功能缺损的关联与活动能力的大幅下降密切相关。同样，影像学检查显示有新转移灶以及既有转移灶扩大的患者更有可能丧失活动能力。
骨转移的总负担、具体位置和总体分布并不能预测失能情况。肺癌相关骨转移患者，当其转移灶在大小和数量上增加，或与疼痛或新的神经功能缺损相关时，活动能力下降的风险显著增加。
