Konovalov N A, Nazarenko A G, Asyutin D S, Solenkova A V, Onoprienko R A, Zakirov B A, Timonin S Yu, Cherkiev I U, Martynova M A, Kosyr'kova A V, Korolishin V A
Burdenko Neurosurgical Institute, Moscow, Russia.
Burdenko Neurosurgical Institute, Moscow, Russia; Clinical Hospital #1, Moscow, Russia.
Zh Vopr Neirokhir Im N N Burdenko. 2015;79(3):34-44. doi: 10.17116/neiro201579334-44.
Every year the number of cancer patients increases due to increased life expectancy. According to various sources, metastases in the spine are found during autopsy in 30-90% of patients with a history of cancer. So far, there have been no full-scale studies of the quality of life of patients with various metastatic tumors of the spine who underwent surgical treatment in Russian literature. The main objective of this study was to demonstrate the need for implementing the comprehensive treatment of patients with metastases in the spine and target setting as the main tool to identify the factors that adversely affect the patients' quality of life.
The quality of life of 56 patients aged 16 to 81 years was assessed, including 26 males and 30 females. Twenty-six patients underwent surgical treatment between 2002 and 2009, and thirty patients underwent surgical treatment between 2009 and 2014. Kidney cancer was a primary disease in 30.3% of patients, multiple myeloma was a primary disease in 23.1% of cases, and the primary source of a tumor was not identified in cancer screening in 10.5% of cases. There were also isolated cases of melanoma, thymoma, metastases of tumors of the gastrointestinal tract, uterus, ovary, lung, prostate, pancreas, and the thyroid gland, which on the average amounted to 3.5% (1.8 to 7.14%). The quality of life of patients was studied using the EORTC QLQ C30 scale. The patients were surveyed prior to the surgery and then 1, 3, 6 and 12 months after surgical treatment during 1 year or until death. Preoperative and postoperative contrast-enhanced SCT and MRI examinations were used to control the extent of decompression of neural structures.
On the basis of these findings, the authors identified the main factors affecting the quality of life of patients and formulated a range of treatment goals for patients with metastases in the spine.
Surgical treatment has a positive effect on the quality of life of patients with metastases in the spine. However, it is not a key factor in the context of survival rate of these patients. Therefore, a decision on the possibility and necessity of surgical treatment should be taken in cooperation with the patient and oncologists of different specialties.
由于预期寿命的增加，每年癌症患者的数量都在上升。根据各种资料来源，在有癌症病史的患者尸检中，发现脊柱转移的比例为30%至90%。迄今为止，俄罗斯文献中尚未对接受手术治疗的各种脊柱转移性肿瘤患者的生活质量进行全面研究。本研究的主要目的是证明对脊柱转移患者实施综合治疗的必要性，并将目标设定作为识别对患者生活质量产生不利影响因素的主要工具。
评估了56例年龄在16至81岁之间患者的生活质量，其中男性26例，女性30例。26例患者在2002年至2009年间接受了手术治疗，30例患者在2009年至2014年间接受了手术治疗。30.3%的患者原发性疾病为肾癌，23.1%的病例原发性疾病为多发性骨髓瘤，10.5%的病例在癌症筛查中未发现肿瘤的原发来源。此外，还有黑色素瘤、胸腺瘤、胃肠道肿瘤、子宫、卵巢、肺、前列腺、胰腺和甲状腺肿瘤转移的个别病例，平均占3.5%（1.8%至7.14%）。使用欧洲癌症研究与治疗组织生活质量核心问卷C30量表研究患者的生活质量。在手术前以及手术后1年或直至死亡的1、3、6和12个月对患者进行调查。术前和术后使用对比增强螺旋CT和MRI检查来控制神经结构减压的程度。
基于这些发现，作者确定了影响患者生活质量的主要因素，并为脊柱转移患者制定了一系列治疗目标。
手术治疗对脊柱转移患者的生活质量有积极影响。然而，在这些患者的生存率方面，它不是关键因素。因此，应与患者和不同专业的肿瘤学家合作，决定手术治疗的可能性和必要性。
