Kobayashi Takashi, Miyakoshi Naohisa, Abe Toshiki, Abe Eiji, Kikuchi Kazuma, Shimada Yoichi, Matsumoto Seiko, Fukui Shin
Department of Orthopedic Surgery, Akita Kousei Medical Center, 1-1-1 Iijima, Nishifukuro, Akita, 011-0948, Japan.
Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
J Med Case Rep. 2017 Jan 4;11(1):4. doi: 10.1186/s13256-016-1157-3.
Spinal metastasis is considered to have a worse prognosis in lung cancer than in other cancers, but recent clinical studies report improved overall survival of lung cancer. We compared the postoperative prognoses of vertebral metastatic tumors from lung with other types of cancer.
From 2011 to 2015, 31 Japanese patients (mean age 73 years, range 55-88 years; 19 males, 12 females) underwent surgery for spinal metastasis at our center. We observed patients retrospectively in March 2016, dividing them into groups by cancer type: lung (LK group, n = 10); prostate, breast, or thyroid (PB group, n = 12); and other (OT group, n = 9). We compared survival and revised Tokuhashi score, which provides a basis for choosing a treatment course. Neurologic status was graded before and after surgery using the Frankel system.
Mean follow-up was 16.5 months (range 1-62 months). Only seven of 31 patients (22.6%) were alive at final follow-up. Frankel grade significantly improved postoperatively only in the LK (P = 0.01) and PB (P = 0.048) groups. Revised Tokuhashi score differed across groups (P < 0.0001), and was significantly lower in the LK group than in the PB group (P = 0.00) and OT group (P = 0.02). Postoperative survival was significantly shorter in the LK group than in the PB group (P = 0.01) but did not differ between the LK and OT groups.
The revised Tokuhashi score may underestimate the survival of lung cancer patients, who may derive the same benefit from surgical intervention as those with vertebral metastasis from other cancer types.
与其他癌症相比，肺癌脊柱转移被认为预后更差，但近期临床研究报告显示肺癌患者的总生存期有所改善。我们比较了肺癌椎体转移瘤与其他类型癌症术后的预后情况。
2011年至2015年，31例日本患者（平均年龄73岁，范围55 - 88岁；男性19例，女性12例）在我们中心接受了脊柱转移瘤手术。2016年3月我们对患者进行了回顾性观察，根据癌症类型将他们分为：肺癌组（LK组，n = 10）；前列腺癌、乳腺癌或甲状腺癌组（PB组，n = 12）；以及其他组（OT组，n = 9）。我们比较了生存率和修订的Tokuhashi评分，后者为选择治疗方案提供依据。术前和术后使用Frankel系统对神经功能状态进行分级。
平均随访时间为16.5个月（范围1 - 62个月）。最终随访时31例患者中仅7例（22.6%）存活。术后Frankel分级仅在LK组（P = 0.01）和PB组（P = 0.048）有显著改善。修订的Tokuhashi评分在各组间存在差异（P < 0.0001），LK组显著低于PB组（P = 0.00）和OT组（P = 0.02）。LK组术后生存期显著短于PB组（P = 0.01），但LK组与OT组之间无差异。
修订的Tokuhashi评分可能低估了肺癌患者的生存期，肺癌患者可能与其他癌症类型椎体转移患者一样能从手术干预中获益。
