Bollen L, Jacobs W C H, Van der Linden Y M, Van der Hel O, Taal W, Dijkstra P D S
Department of Orthopedic Surgery, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands.
Eur Spine J. 2018 Apr;27(4):799-805. doi: 10.1007/s00586-017-5320-3. Epub 2017 Oct 24.
For the selection of treatment in patients with spinal bone metastases (SBM), survival estimation plays a crucial role to avoid over- and under-treatment. To aid clinicians in this difficult task, several prediction models have been developed, consisting of many different risk factors. The aim of this systematic review was to identify prognostic factors that are associated with survival in patients with SBM to support development of predictive models.
A systematic review was performed with focus on prognostic factors associated with survival in patients with SBM. Two reviewers independently selected studies for inclusion and assessed the risk of bias. A level of evidence synthesis was performed for each prognostic factor. Inter-observer agreement for the risk of bias assessment was determined by the kappa-statistic.
After screening, 142 full-text articles were obtained, of which 22 met the eligibility criteria. A total of 43 different prognostic factors were investigated in the included studies, of which 17 were relevant to pre-treatment survival estimation. The prognostic factors most frequently associated with survival were the primary tumor and the performance status. The prognostic factors most frequently not associated with survival were age, gender, number and location of the SBM and the presence of a pathologic fracture.
Prognostication for patients with SBM should be based on an accurate primary tumor classification, combined with a performance score. The benefit of adding other prognostic factors is doubtful.
对于脊柱骨转移瘤（SBM）患者的治疗选择而言，生存预估对于避免过度治疗和治疗不足起着关键作用。为帮助临床医生完成这项艰巨任务，已开发了多种预测模型，这些模型包含许多不同的风险因素。本系统评价的目的是确定与SBM患者生存相关的预后因素，以支持预测模型的开发。
进行了一项系统评价，重点关注与SBM患者生存相关的预后因素。两名评价者独立选择纳入研究并评估偏倚风险。对每个预后因素进行证据合成水平评估。通过kappa统计量确定观察者间在偏倚风险评估方面的一致性。
筛选后获得142篇全文文章，其中22篇符合纳入标准。纳入研究共调查了43种不同的预后因素，其中17种与治疗前生存预估相关。与生存最常相关的预后因素是原发肿瘤和体能状态。最常与生存不相关的预后因素是年龄、性别、SBM的数量和位置以及病理性骨折的存在。
SBM患者的预后评估应基于准确的原发肿瘤分类，并结合体能评分。添加其他预后因素的益处值得怀疑。
