Yang Jian, Jia Qi, Peng Dongyu, Wan Wei, Zhong Nanzhe, Lou Yan, Cai Xiaopan, Wu Zhipeng, Zhao Chenglong, Yang Xinghai, Xiao Jianru
Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China.
World J Surg Oncol. 2017 Jan 14;15(1):21. doi: 10.1186/s12957-016-1085-0.
The surgical treatment of upper cervical spine metastases are controversial up to now. By summarizing and analyzing the clinical data of the upper cervical spine involved metastases treated surgically in our center, we mainly aimed to investigate the surgical decisions and outcomes so as to provide more references for the clinical treatment of this special and complex spine metastasis.
We evaluated the patients' pre- and post-operative neck pain and neurologic function with paired t test, followed by the statistics of the selection of surgical approaches, ways of reconstruction, and related complications. Moreover, the Kaplan-Meier survival analysis was adopted to analyze the patients' survival according to different growth group (rapid, moderate, and slow).
There were 39 patients with atlantoaxial metastases in this study. The most common symptom (94.87%) was occipital-cervical pain, which relieved greatly after surgical interventions (p < 0.01). The metastases mainly resulted from lung cancer and nasopharyngeal cancer with an incidence of 38.46 and 10.26%, respectively. As to different growth group, the rapid-growth tumors accounted for 69.23% in all atlantoaxial metastases. Tumor resection and stabilization were performed mainly via the combined anterior and posterior approach (66.67%). The 1-, 2-, and 3-year overall survival rate at the last follow-up was 58.5, 40, and 28.3%, respectively, with a median survival time of 18 months. The rate of complications associated with the surgical intervention was 12.82% (5/39), which is lower than that of the previous reports and generally controllable.
Relatively radical interventions with surgery for upper cervical spine metastases offered satisfactory outcomes with a low mortality. Together with adjuvant therapy, surgical treatment benefits patients with atlantoaxial metastases by relieving regional pain, restoring or improving the neurologic function, stabilizing the quality of life, and prolonging the survival time of such patients.
目前，上颈椎转移瘤的外科治疗仍存在争议。通过总结和分析我院中心手术治疗的上颈椎转移瘤患者的临床资料，我们主要旨在探讨手术决策和结果，以便为这种特殊且复杂的脊柱转移瘤的临床治疗提供更多参考。
我们采用配对t检验评估患者术前和术后的颈部疼痛及神经功能，随后统计手术入路的选择、重建方式及相关并发症。此外，采用Kaplan-Meier生存分析根据不同生长组（快速、中度和缓慢）分析患者的生存情况。
本研究中有39例寰枢椎转移瘤患者。最常见的症状（94.87%）是枕颈部疼痛，手术干预后疼痛明显缓解（p < 0.01）。转移瘤主要源于肺癌和鼻咽癌，发生率分别为38.46%和10.26%。在不同生长组中，快速生长肿瘤在所有寰枢椎转移瘤中占69.23%。肿瘤切除和稳定主要通过前后联合入路进行（66.67%）。末次随访时1年、2年和3年的总生存率分别为58.5%、40%和28.3%，中位生存时间为18个月。手术干预相关并发症发生率为12.82%（5/39），低于既往报道，且一般可控。
对上颈椎转移瘤进行相对积极的手术干预可获得满意的结果，死亡率较低。与辅助治疗一起，手术治疗通过缓解局部疼痛、恢复或改善神经功能、稳定生活质量以及延长此类患者的生存时间，使寰枢椎转移瘤患者受益。
