Goodwin C Rory, Ahmed A Karim, Boone Christine, Abu-Bonsrah Nancy, Xu Risheng, Germscheid Niccole, Fourney Daryl R, Clarke Michelle, Laufer Ilya, Fisher Charles G, Bettegowda Chetan, Sciubba Daniel M
Duke University Medical Center, Durham, NC, USA.
These authors contributed equally to this manuscript.
Global Spine J. 2018 Aug;8(5):517-526. doi: 10.1177/2192568217737777. Epub 2017 Nov 20.
Systematic review.
The objective of this systematic review was to answer 2 key questions: (1) What is the clinical presentation and probability of symptomatic improvement following treatment for patients with renal cell carcinoma (RCC) of the spine? (2) What is the overall survival of patients diagnosed with spinal metastases from RCC?
A literature review was performed to identify articles that reported on survival, clinical outcomes, and/or prognostic factors in the RCC population with spinal metastases from 1986 to 2016.
Forty-eight articles (807 patients) were included. The Fuhrman Nuclear Grade has been significantly associated with survival in previous studies but was underpowered in the current study. The Memorial Sloan-Kettering Cancer Center Score (MSKCC/Motzer) was also underpowered in the current study. From the time of spinal metastasis, the mean and median survival for patients with previously diagnosed primary RCC was 8.75 and 11.7 months, respectively, whereas synchronously diagnosed patients (primary RCC and spinal metastasis) had a mean and median survival of 6.75 and 11 months, respectively. Patients with a "low" (0-8), "intermediate" (9-11), or "high" (12-15) revised Tokuhashi score at initial presentation had a median survival of 5.4, 11.7, and 32.9 months, respectively.
Patients with either a synchronous or latent diagnosis of RCC survived greater than 6 months from the time of presentation. Initial Furhman grade, Tokuhashi score, and MSKCC/Motzer can be useful tools in informing patient-specific prognosis for those with metastatic RCC of the spine.
系统评价。
本系统评价的目的是回答两个关键问题：（1）脊柱肾细胞癌（RCC）患者治疗后的临床表现及症状改善的可能性如何？（2）诊断为RCC脊柱转移的患者的总生存期如何？
进行文献综述以识别1986年至2016年期间报道RCC脊柱转移患者的生存、临床结局和/或预后因素的文章。
纳入48篇文章（807例患者）。Fuhrman核分级在先前研究中与生存显著相关，但在本研究中效力不足。纪念斯隆凯特琳癌症中心评分（MSKCC/Motzer）在本研究中同样效力不足。从脊柱转移时起，先前诊断为原发性RCC的患者的平均生存期和中位生存期分别为8.75个月和11.7个月，而同时诊断的患者（原发性RCC和脊柱转移）的平均生存期和中位生存期分别为6.75个月和11个月。初次就诊时修订Tokuhashi评分为“低”（0 - 8）、“中”（9 - 11）或“高”（12 - 15）的患者的中位生存期分别为5.4个月、11.7个月和32.9个月。
无论是同步诊断还是潜伏诊断的RCC患者，从就诊时起生存期均超过6个月。初始Fuhrman分级、Tokuhashi评分和MSKCC/Motzer可作为告知脊柱转移性RCC患者个体特异性预后的有用工具。
