Tan Jiong Hao, Tan Kimberly-Anne, Zaw Aye Sandar, Thomas Andrew Cherian, Hey Hwee Weng, Soo Ross Andrew, Kumar Naresh
*University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Faculty of Medicine Singapore†Faculty of Medicine, University of New South Wales, Sydney, Australia‡Faculty of Medicine, Royal College of Surgeons in Ireland§National University Cancer Institute, National University Hospital, Singapore.
Spine (Phila Pa 1976). 2016 Apr;41(7):638-44. doi: 10.1097/BRS.0000000000001279.
A retrospective study of 180 patients with lung cancer spinal metastases, wherein prognostic score-predicted survival was compared with actual survival.
To evaluate and compare the accuracy of prognostic scoring systems in lung cancer spinal metastases.
The modified Tokuhashi, Tomita, modified Bauer, and Oswestry scores are currently used to guide decisions regarding operative treatment of patients with spinal metastases. The best system for predicting survival in patients with lung cancer spinal metastases remains undetermined. The high incidence of spinal metastases from lung cancer and improved survival of patients treated with systemic therapy warrants evaluation of these scoring systems in this particular context.
Patients with lung cancer spinal metastases treated at our institution between May 2001 and August 2012 were studied. Fifty-one patients were treated surgically. The primary outcome measure was survival from the time of diagnosis. Scoring-predicted survival was compared with actual survival. Potential prognostic factors were investigated using Cox regression analyses. Predictive values of each scoring system for 3- and 6-month survival were measured via receiver operating characteristic (ROC) curves.
Histological subtype (P = 0.015), sex (P = 0.001), Karnofsky performance scale (P = 0.001), extent of neurological palsy (P = 0.002), and visceral metastases (P = 0.037) are significant predictors of survival. Besides the Oswestry spinal risk index, no significant differences were found between different prognostic subgroups within the individual scoring systems. Although the modified Bauer score was most accurate, all four scoring systems had areas under the ROC curve 0.5 or less.
Although better prognostic scores correlated with longer survival, all four scoring systems are inaccurate in prognosticating patients with lung cancer spinal metastases. Specific lung cancer histology appears prognostic and should be considered, especially given the increased survival of patients receiving new targeted therapies appropriate to their disease.
对180例肺癌脊柱转移患者进行回顾性研究，比较预后评分预测的生存期与实际生存期。
评估并比较肺癌脊柱转移预后评分系统的准确性。
改良Tokuhashi、Tomita、改良Bauer和Oswestry评分目前用于指导脊柱转移患者手术治疗的决策。预测肺癌脊柱转移患者生存期的最佳系统仍未确定。肺癌脊柱转移的高发病率以及接受全身治疗患者生存期的延长，使得在这种特定情况下对这些评分系统进行评估很有必要。
研究2001年5月至2012年8月在我院接受治疗的肺癌脊柱转移患者。51例患者接受了手术治疗。主要观察指标为从诊断时起的生存期。将评分预测的生存期与实际生存期进行比较。使用Cox回归分析研究潜在的预后因素。通过受试者工作特征（ROC）曲线测量每个评分系统对3个月和6个月生存期的预测价值。
组织学亚型（P = 0.015）、性别（P = 0.001）、卡氏功能状态评分（P = 0.001）、神经麻痹程度（P = 0.002）和内脏转移（P = 0.037）是生存期的显著预测因素。除了Oswestry脊柱风险指数外，在各个评分系统的不同预后亚组之间未发现显著差异。尽管改良Bauer评分最准确，但所有四个评分系统的ROC曲线下面积均为0.5或更低。
尽管较好的预后评分与较长的生存期相关，但所有四个评分系统在预测肺癌脊柱转移患者的预后方面都不准确。特定的肺癌组织学似乎具有预后意义，应予以考虑，特别是考虑到接受适合其疾病的新靶向治疗的患者生存期有所延长。
3级。
