Guo Marissa, Kolberg Kristen L, Smith Eleanor C, Smith Brandon W, Yousif Jonah E, Kessler Jason L, Linzey Joseph R, Calinescu Anda-Alexandra, Clines Gregory A, Spratt Daniel E, Szerlip Nicholas J
Medical School, University of Michigan, Ann Arbor, Michigan, USA.
Central Michigan University School of Medicine, Mount Pleasant, Michigan, USA.
World Neurosurg. 2018 Nov;119:e991-e996. doi: 10.1016/j.wneu.2018.08.029. Epub 2018 Aug 13.
Spinal metastases pose significant morbidity. For many histologies, the spine is a frequent site for bone metastases. This predilection is not fully understood, and there are conflicting reports regarding the distribution within the vertebral body itself. Knowing this distribution will give clues as to the underlying biologic reason for this increased incidence in the spine and lead to a better understanding of tumor dispersion and growth.
We retrospectively examined magnetic resonance imaging scans of patients undergoing radiation to the spine from 2015 to 2017 for spinal metastases. The anatomical distribution of lesions was categorized. Lesions were sorted along the sagittal plane into 5 groups: anterior only, anterior + middle, middle only, posterior + middle, and posterior only. Lesions that covered all groups were discarded. χ and post-hoc analyses were used for statistical analyses.
Three hundred metastatic lesions were examined in 89 patients; 203 lesions were used for analysis. Sixty-five percent of all lesions were found in posterior only and posterior + middle aspects of the vertebral body (P < 0.0001). This localization was significant regardless of histology: lung (67%, P < 0.0001), kidney (66%, P < 0.0001), sarcoma (67%, P < 0.0001), prostate (63%, P = 0.01), and breast (63%, P = 0.01). This was consistent across thoracic (n = 96) and lumbar (n = 63) regions (72% and 64%, respectively, P < 0.0001).
Metastatic lesions of the thoracolumbar spine have a greater propensity to localize to the posterior aspect of the vertebral body. These data support the hypothesis that there may be differences within the vertebral body leading to differential tumor dispersion and growth.
脊柱转移瘤会引发严重的发病率。对于多种组织学类型而言，脊柱是骨转移的常见部位。这种偏好尚未完全明确，关于椎体内部的分布也存在相互矛盾的报道。了解这种分布将为脊柱发病率增加的潜在生物学原因提供线索，并有助于更好地理解肿瘤的扩散和生长。
我们回顾性分析了2015年至2017年因脊柱转移瘤接受脊柱放疗的患者的磁共振成像扫描结果。对病变的解剖分布进行分类。病变沿矢状面分为5组：仅前部、前部 + 中部、仅中部、后部 + 中部、仅后部。覆盖所有组的病变被排除。采用χ检验和事后分析进行统计分析。
对89例患者的300个转移瘤病变进行了检查；203个病变用于分析。所有病变的65%位于椎体的仅后部和后部 + 中部区域（P < 0.0001）。无论组织学类型如何，这种定位都很显著：肺癌（67%，P < 0.0001）、肾癌（66%，P < 0.0001）、肉瘤（67%，P < 0.0001）、前列腺癌（63%，P = 0.01）和乳腺癌（63%，P = 0.01）。在胸椎（n = 96）和腰椎（n = 63）区域均一致（分别为72%和64%，P < 0.0001）。
胸腰椎的转移瘤病变更倾向于定位于椎体的后部。这些数据支持这样的假设，即椎体内可能存在差异，导致肿瘤的扩散和生长有所不同。
