Nater Anick, Tetreault Lindsay L, Davis Aileen M, Sahgal Arjun A, Kulkarni Abhaya V, Fehlings Michael G
Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada.
World Neurosurg. 2016 Sep;93:436-448.e15. doi: 10.1016/j.wneu.2016.07.018. Epub 2016 Jul 15.
Accurate prediction of surgical outcomes in patients suffering from metastatic epidural spinal cord compression (MESCC) is challenging. This survey aims to obtain expert opinion on which preoperative clinical factors are the most relevant predictors of survival, neurologic, functional, and health-related quality of life (HRQoL).
Members of AOSpine International were invited to participate in a 15-question electronic survey. Results from the entire sample and differences across geographic regions and between neurosurgeons and orthopedic surgeons were analyzed. Factors endorsed by over 50% of the respondents were considered key predictors.
Among AOSpine members, 438 responded. The absence of visceral metastasis (n = 335; 76.48%) and the site of primary tumor (n = 228; 52.05%) were identified as important predictors for survival. Frankel/American Spinal Injury Association grade D or E and the ability to walk were common to neurologic (n = 344; 78.54% and n = 238; 54.34%, respectively); functional (n = 269; 61.42% and n = 243; 55.48%, respectively); and HRQoL outcomes (n = 241; 55.02% and n = 242; 55.25%, respectively). While the absence of bowel/bladder/sexual dysfunction was common to neurologic (n = 260; 59.36%) and HRQoL (n = 229; 52.28%) outcomes, a high Karnofsky/Eastern Cooperative Oncology Group performance status was common to functional (n = 237; 54.11%) and HRQoL (n = 221; 50.46%) outcomes. There was overall consistency across specialities and geographic regions.
Neurosurgeons and orthopedic surgeons and respondents from different geographic regions generally identified similar preoperative clinical factors as key predictors of survival, neurologic, functional, and HRQoL outcomes in surgical MESCC patients. The results of this survey will inform the development of clinical prediction rules for survival and HRQoL in MESCC patients selected for surgery to maximize their clinical relevance.
准确预测转移性硬膜外脊髓压迫症（MESCC）患者的手术结局具有挑战性。本调查旨在就哪些术前临床因素是生存、神经功能、功能以及健康相关生活质量（HRQoL）的最相关预测指标获取专家意见。
邀请国际脊柱学会（AOSpine）成员参与一项包含15个问题的电子调查。分析了整个样本的结果以及不同地理区域之间、神经外科医生和骨科医生之间的差异。超过50%的受访者认可的因素被视为关键预测指标。
在脊柱学会成员中，438人做出了回应。无内脏转移（n = 335；76.48%）和原发肿瘤部位（n = 228；52.05%）被确定为生存的重要预测指标。Frankel/美国脊髓损伤协会D级或E级以及行走能力在神经功能（分别为n = 344；78.54%和n = 238；54.34%）、功能（分别为n = 269；61.42%和n = 243；55.48%）和HRQoL结局（分别为n = 241；55.02%和n = 242；55.25%）方面较为常见。虽然无肠道/膀胱/性功能障碍在神经功能（n = 260；59.36%）和HRQoL（n = 229；52.28%）结局方面较为常见，但高卡诺夫斯基/东部肿瘤协作组体能状态在功能（n = 237；54.11%）和HRQoL（n = 221；50.46%）结局方面较为常见。各专业和地理区域之间总体上具有一致性。
神经外科医生、骨科医生以及来自不同地理区域的受访者普遍确定了相似的术前临床因素，作为手术治疗MESCC患者生存、神经功能、功能和HRQoL结局的关键预测指标。本次调查结果将为制定MESCC手术患者生存和HRQoL的临床预测规则提供依据，以使其临床相关性最大化。
