Ma Yifei, He Shaohui, Liu Tielong, Yang Xinghai, Zhao Jian, Yu Hongyu, Feng Jiaojiao, Xu Wei, Xiao Jianru
1Departments of Orthopaedic Oncology (Y.M., S.H., T.L., X.Y., J.Z., W.X., and J.X.), Pathology (H.Y.), and Human Resources (J.F.), Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China.
J Bone Joint Surg Am. 2017 Oct 4;99(19):1629-1639. doi: 10.2106/JBJS.16.00286.
Patients with spinal metastasis from cancer of unknown primary origin have limited life expectancy and poor quality of life. Surgery and radiation therapy remain the main treatment options, but, to our knowledge, there are limited data concerning quality-of-life improvement after surgery and radiation therapy and even fewer data on whether surgical intervention would affect quality of life.
Patients were enrolled between January 2009 and January 2014 at the Changzheng Hospital, Shanghai, People's Republic of China. The quality of life of 2 patient groups (one group that underwent surgery followed by postoperative radiation therapy and one group that underwent radiation therapy only) was assessed by the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire during a 6-month period. A subgroup analysis of quality of life was performed to compare different surgical strategies in the surgical group.
A total of 287 patients, including 191 patients in the group that underwent surgery and 96 patients in the group that underwent radiation therapy only, were enrolled in the prospective study; 177 patients completed all 5 checkpoints and 110 patients had died by the final checkpoint. The surgery group had significantly higher adjusted quality-of-life scores than the radiation therapy group in each domain of the FACT-G questionnaire (all p < 0.05). Subgroup analysis showed that adjusted functional and physical well-being scores were higher in the circumferential surgical decompression group.
Surgery followed by postoperative radiation therapy improved and maintained quality of life in patients with spinal metastasis from cancer of unknown primary origin in the 6-month assessment. In terms of surgical strategies, circumferential decompression seems better than laminectomy alone in quality-of-life improvement.
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
原发灶不明的癌症脊柱转移患者预期寿命有限，生活质量较差。手术和放射治疗仍是主要的治疗选择，但据我们所知，关于手术和放射治疗后生活质量改善的数据有限，而关于手术干预是否会影响生活质量的数据更少。
2009年1月至2014年1月期间，在中国上海长征医院招募患者。在6个月的时间里，通过癌症治疗功能评估通用问卷（FACT-G）对两组患者（一组接受手术及术后放射治疗，另一组仅接受放射治疗）的生活质量进行评估。对手术组的不同手术策略进行生活质量亚组分析。
共有287例患者纳入前瞻性研究，其中手术组191例，仅接受放射治疗组96例；177例患者完成了所有5个检查点，110例患者在最后一个检查点时死亡。在FACT-G问卷的各个领域，手术组的调整后生活质量得分均显著高于放射治疗组（所有p<0.05）。亚组分析显示，环形手术减压组的调整后功能和身体幸福感得分更高。
在6个月的评估中，手术及术后放射治疗改善并维持了原发灶不明的癌症脊柱转移患者的生活质量。就手术策略而言，在改善生活质量方面，环形减压似乎优于单纯椎板切除术。
治疗水平II。有关证据水平的完整描述，请参阅作者指南。
