术前神经状态对有脊髓压迫症状的脊柱转移瘤手术治疗后生存情况的影响。

Influence of the Preoperative Neurological Status on Survival After the Surgical Treatment of Symptomatic Spinal Metastases With Spinal Cord Compression.

作者信息

Vanek Petr, Bradac Ondrej, Trebicky Ferdinand, Saur Karel, de Lacy Patricia, Benes Vladimir

机构信息

*Department of Neurosurgery and Neurooncology, Military University Hospital and Charles University, First Medical Faculty, Prague, Czech Republic †Department of Radiation Oncology, Na Bulovce Hospital and Charles University, First Medical Faculty, Prague, Czech Republic ‡Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, UK.

出版信息

Spine (Phila Pa 1976). 2015 Dec;40(23):1824-30. doi: 10.1097/BRS.0000000000001141.

DOI:10.1097/BRS.0000000000001141

PMID:26536440

Abstract

STUDY DESIGN

Consecutive case-series.

OBJECTIVE

The main purpose of this study was to analyze the relationship between the preoperative neurological status and subsequent survival of patients undergoing surgical treatment for symptomatic spinal metastases.

SUMMARY OF BACKGROUND DATA

The survival of cancer patients has increased over recent years with improvements in oncologic therapy. As many as 70% of cancer patients develop spinal metastases and ∼10% of all cancer patients are treated for metastatic spinal cord compression.

METHODS

We retrospectively analyzed 166 patients who underwent surgery for symptomatic spinal metastases in our department between 2005 and 2012. The evaluated factors were age, primary tumor aggressiveness (slow, moderate, rapid growing), spinal location (cervical, thoracic, lumbar, and sacral), operation type (posterior decompression, anterior or posterior instrumented procedure, and radical combined instrumented surgery), preoperative evaluation using the revised Tokuhashi scoring system (<9, 9-11, and 12-15), pre- and postoperative neurological status according to the Frankel score (A-C and D-E), and the site of the main spinal cord compression (anterior, posterior, or combined). Postoperative complication and recurrence rate were also monitored.

RESULTS

The mean age of the patients was 62 ± 12 years. The median survival time after surgery was 16.0 months. Preoperative neurological status influenced survival time significantly; the median survival was 5.1 months in Frankel A-C and 28.2 months in Frankel D-E (P < 0.001). Improvement on the Frankel scale did not influence the survival time (P = 0.131). When the patients' age was <65 years this related to a significantly longer survival time (P = 0.046). The Tokuhashi score predicted patient's survival independently (P < 0.001). The other factors had no statistical significance.

CONCLUSION

The most important factors influencing postoperative survival time of these patients with symptomatic spinal metastases was the preoperative neurological condition and the Tokuhashi scoring system, which together represents a useful tool for planning the extent of surgical treatment.

摘要

研究设计

连续病例系列研究。

目的

本研究的主要目的是分析有症状脊柱转移瘤患者术前神经状态与术后生存之间的关系。

背景资料总结

近年来，随着肿瘤治疗的改善，癌症患者的生存率有所提高。多达70%的癌症患者会发生脊柱转移，所有癌症患者中有10%因转移性脊髓压迫而接受治疗。

方法

我们回顾性分析了2005年至2012年期间在我科接受有症状脊柱转移瘤手术的166例患者。评估因素包括年龄、原发肿瘤侵袭性（生长缓慢、中等、快速）、脊柱位置（颈椎、胸椎、腰椎和骶椎）、手术类型（后路减压、前路或后路器械辅助手术以及根治性联合器械手术）、使用修订的Tokuhashi评分系统进行的术前评估（<9、9 - 11和12 - 15）、根据Frankel评分的术前和术后神经状态（A - C和D - E）以及主要脊髓压迫部位（前部、后部或联合）。还监测了术后并发症和复发率。

结果

患者的平均年龄为62±12岁。术后中位生存时间为16.0个月。术前神经状态对生存时间有显著影响；Frankel A - C组的中位生存时间为5.1个月，Frankel D - E组为28.2个月（P<0.001）。Frankel评分的改善对生存时间没有影响（P = 0.131）。当患者年龄<65岁时，生存时间显著更长（P = 0.046）。Tokuhashi评分可独立预测患者的生存（P<0.001）。其他因素无统计学意义。