手术治疗转移性硬膜外脊髓压迫症患者的生存和临床结局：前瞻性多中心 AOSpine 研究结果。
Survival and Clinical Outcomes in Surgically Treated Patients With Metastatic Epidural Spinal Cord Compression: Results of the Prospective Multicenter AOSpine Study.
机构信息
Michael G. Fehlings, Anick Nater, Lindsay Tetreault, and Eric Massicotte, University of Toronto; Joel Finkelstein and Arjun Sahgal, Sunnybrook Health Sciences Center, Toronto, Ontario; Charles Fisher, University of British Columbia and Vancouver Coastal Health, Vancouver, British Columbia, Canada; Branko Kopjar, University of Washington, Seattle, WA; Paul Arnold, University of Kansas, Kansas City, KS; Mark Dekutoski, The CORE Institute, Sun City West, AZ; John France, West Virginia University, Morgantown, WV; Ziya Gokaslan, Johns Hopkins University School of Medicine, Baltimore, MD; Laurence Rhines, MD Anderson Cancer Center, Houston, TX; Peter Rose, Mayo Clinic, Rochester, MN; James Schuster, University of Pennsylvania; and Alexander Vaccaro, Thomas Jefferson University, Philadelphia, PA.
出版信息
J Clin Oncol. 2016 Jan 20;34(3):268-76. doi: 10.1200/JCO.2015.61.9338. Epub 2015 Nov 23.
PURPOSE
Although surgery is used increasingly as a strategy to complement treatment with radiation and chemotherapy in patients with metastatic epidural spinal cord compression (MESCC), the impact of surgery on health-related quality of life (HRQoL) is not well established. We aimed to prospectively evaluate survival, neurologic, functional, and HRQoL outcomes in patients with MESCC who underwent surgical management.
PATIENTS AND METHODS
One hundred forty-two patients with a single symptomatic MESCC lesion who were treated surgically were enrolled onto a prospective North American multicenter study and were observed at least up to 12 months. Clinical data, including Brief Pain Inventory, ASIA (American Spinal Injury Association) impairment scale, SF-36 Short Form Health Survey, Oswestry Disability Index, and EuroQol 5 dimensions (EQ-5D) scores, were obtained preoperatively, and at 6 weeks and 3, 6, 9, and 12 months postoperatively.
RESULTS
Median survival time was 7.7 months. The 30-day and 12-month mortality rates were 9% and 62%, respectively. There was improvement at 6 months postoperatively for ambulatory status (McNemar test, P < .001), lower extremity and total motor scores (Wilcoxon signed rank test, P < .001), and at 6 weeks and 3, 6, and 12 months for Oswestry Disability Index, EQ-5D, and pain interference (paired t test, P < .013). Moreover, at 3 months after surgery, the ASIA impairment scale grade was improved (Stuart-Maxwell test P = .004). SF-36 scores improved postoperatively in six of eight scales. The incidence of wound complications was 10% and 2 patients required a second surgery (screw malposition and epidural hematoma).
CONCLUSION
Surgical intervention, as an adjunct to radiation and chemotherapy, provides immediate and sustained improvement in pain, neurologic, functional, and HRQoL outcomes, with acceptable risks in patients with a focal symptomatic MESCC lesion who have at least a 3 month survival prognosis.
目的
尽管手术作为一种策略，在转移性硬膜外脊髓压迫症（MESCC）患者中与放疗和化疗联合应用越来越普遍，但手术对健康相关生活质量（HRQoL）的影响尚未明确。我们旨在前瞻性评估接受手术治疗的 MESCC 患者的生存、神经功能、功能和 HRQoL 结果。
方法
142 例单一症状性 MESCC 病变患者接受手术治疗，入组前瞻性北美多中心研究，并至少随访 12 个月。在术前，以及术后 6 周、3、6、9 和 12 个月时，获取临床数据，包括简明疼痛量表（Brief Pain Inventory）、美国脊柱损伤协会（ASIA）损伤量表、SF-36 健康调查简表（SF-36 Short Form Health Survey）、Oswestry 残疾指数（Oswestry Disability Index）和欧洲五维健康量表（EQ-5D）评分。
结果
中位生存时间为 7.7 个月。30 天和 12 个月的死亡率分别为 9%和 62%。术后 6 个月时，步行状态（McNemar 检验，P<0.001）、下肢和总运动评分（Wilcoxon 符号秩检验，P<0.001）以及术后 6 周、3、6 和 12 个月时 Oswestry 残疾指数、EQ-5D 和疼痛干扰（配对 t 检验，P<0.013）均有改善。此外，术后 3 个月时，ASIA 损伤量表分级得到改善（Stuart-Maxwell 检验，P=0.004）。术后 8 个量表中的 6 个量表的 SF-36 评分均有改善。伤口并发症的发生率为 10%，2 例患者需要再次手术（螺钉位置不当和硬膜外血肿）。
结论
作为放疗和化疗的辅助治疗，手术可即刻并持续改善疼痛、神经功能、功能和 HRQoL 结果，对于生存至少 3 个月的局灶性症状性 MESCC 病变患者，手术具有可接受的风险。
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