Kakutani Kenichiro, Sakai Yoshitada, Maeno Koichiro, Takada Toru, Yurube Takashi, Kurakawa Takuto, Miyazaki Shingo, Terashima Yoshiki, Ito Masaaki, Hara Hitomi, Kawamoto Teruya, Ejima Yasuo, Sakashita Akihiro, Kiyota Naomi, Kizawa Yoshiyuki, Sasaki Ryohei, Akisue Toshihro, Minami Hironobu, Kuroda Ryosuke, Kurosaka Masahiro, Nishida Kotaro
*Department of Orthopaedic Surgery †Division of Rehabilitation Medicine ‡Department of Radiation Oncology §Department of Palliative Medicine ∥Department of Medical Oncology/Hematology ¶Department of Rehabilitation Science, Kobe University Graduate School of Medicine, Kobe, Japan.
Clin Spine Surg. 2017 Oct;30(8):E1026-E1032. doi: 10.1097/BSD.0000000000000456.
A prospective cohort study of performance status (PS) and activities of daily living (ADL) in patients with spinal metastasis.
To identify the effect of spinal surgery on PS and ADL in patients with spinal metastasis.
Spinal metastasis causes severe neurological deficits, resulting in drastic loss of patients' PS and ADL. However, the effect of spine surgery on PS and ADL is not well known.
Seventy patients with spinal metastasis were enrolled in this study. Forty-six patients desired and underwent spine surgery ("surgery" group) and 24 patients did not desire surgery ("nonsurgery" group). Both groups received optimal treatments, including radiation, chemotherapy, and palliative care services. Evaluation was performed at 1, 3, and 6 months after study enrollment using the Eastern Cooperative Oncology Group PS, the Barthel index (BI) for ADL, and Frankel classification for neurological status.
There was no significant difference in baseline PS, the BI, or Frankel classification between the groups. The surgery group showed significant improvement in PS, maintaining grade 2 or less throughout the duration of the study, as well as in ADL, exceeding 70 points of the BI, compared with the nonsurgery group (P<0.05). Significantly improved neurological condition was also observed in the surgery group over the following 6 months. More than 95% of patients who underwent surgery improved their PS, the BI, and neurological status. Furthermore, >80% of these patients maintained improvement in PS, the BI, and neurological status for at least 6 months. In contrast, PS, the BI, and neurological status of patients in the "nonsurgery" group deteriorated throughout the study period.
Spine surgery improves PS, ADL, and neurological status in patients with spinal metastasis for a minimum 6 months. This indicates that these patients can acquire an independent daily life.
一项关于脊柱转移瘤患者的体能状态（PS）和日常生活活动能力（ADL）的前瞻性队列研究。
确定脊柱手术对脊柱转移瘤患者PS和ADL的影响。
脊柱转移瘤会导致严重的神经功能缺损，致使患者的PS和ADL急剧下降。然而，脊柱手术对PS和ADL的影响尚不明确。
本研究纳入了70例脊柱转移瘤患者。46例患者希望并接受了脊柱手术（“手术”组），24例患者不希望接受手术（“非手术”组）。两组均接受了最佳治疗，包括放疗、化疗和姑息治疗服务。在研究入组后的1、3和6个月，使用东部肿瘤协作组的PS、ADL的巴氏指数（BI）以及神经功能状态的Frankel分级进行评估。
两组在基线PS、BI或Frankel分级方面无显著差异。与非手术组相比，手术组在PS方面有显著改善，在整个研究期间维持在2级或更低水平，并且在ADL方面，BI超过70分（P<0.05）。在接下来的6个月中，手术组的神经功能状况也有显著改善。超过95%接受手术的患者在PS、BI和神经功能状态方面有所改善。此外，这些患者中>80%在PS、BI和神经功能状态方面至少维持改善6个月。相比之下，“非手术”组患者的PS、BI和神经功能状态在整个研究期间均恶化。
脊柱手术可改善脊柱转移瘤患者的PS（体能状态）、ADL（日常生活活动能力）和神经功能状态至少6个月。这表明这些患者能够获得独立的日常生活。
