Ohashi Masayuki, Hirano Toru, Watanabe Kei, Hasegawa Kazuhiro, Ito Takui, Katsumi Keiichi, Shoji Hirokazu, Mizouchi Tatsuki, Takahashi Ikuko, Homma Takao, Endo Naoto
Department of Orthopedic Surgery, Niigata University Medical and Dental Hospital, Niigata, Japan.
Niigata Spine Surgery Center, Niigata, Japan.
Asian Spine J. 2019 Apr;13(2):296-304. doi: 10.31616/asj.2018.0145. Epub 2018 Nov 29.
Retrospective case series.
To investigate the oncological outcomes, including distant relapse, after en bloc spondylectomy (EBS) for spinal metastases in patients with a minimum of 2-year follow-up.
Although EBS has been reported to be locally curative and extend survival in select patients with spinal metastases, detailed reports regarding the control of distant relapse after EBS are lacking.
We conducted a retrospective review of 18 consecutive patients (median age at EBS, 62 years; range, 40-77 years) who underwent EBS for spinal metastases between 1991 and 2015. The primary cancer sites included the kidney (n=7), thyroid (n=4), liver (n=3), and other locations (n=4). Survival rates were estimated using the Kaplan-Meier method, and groups were compared using the log-rank method.
The median operative time and intraoperative blood loss were 767.5 minutes and 2,375 g, respectively. Twelve patients (66.7%) experienced perioperative complications. Five patients (27.8%) experienced local recurrence of the tumor at a median of 12.5 months after EBS, four of which had a positive resection margin status. Thirteen patients (72.2%) experienced distant relapse at a median of 21 months after EBS. The estimated median survival period after distant relapse was 20 months (95% confidence interval, 0.71-39.29 months). No association was found between resection margin status and distant relapse. Overall, the 2-year, 5-year, and 10-year survival rates after EBS were 72.2%, 48.8%, and 27.1%, respectively. Importantly, the era in which EBS was performed did not impact the oncological outcomes.
Our results suggest that EBS by itself, even if margin-free, cannot prevent further dissemination, which occurred in >70% of patients at a median of 21 months after EBS. These results should be considered and conveyed to patients for clinical decision-making.
回顾性病例系列研究。
对接受整块脊椎切除术（EBS）治疗脊柱转移瘤且随访至少2年的患者，调查其肿瘤学结局，包括远处复发情况。
尽管已有报道称EBS对部分脊柱转移瘤患者具有局部治愈性并能延长生存期，但缺乏关于EBS后远处复发控制情况的详细报告。
我们对1991年至2015年间连续接受EBS治疗脊柱转移瘤的18例患者（EBS时的中位年龄为62岁；范围40 - 77岁）进行了回顾性研究。原发癌部位包括肾脏（n = 7）、甲状腺（n = 4）、肝脏（n = 3）及其他部位（n = 4）。采用Kaplan-Meier法估计生存率，并用对数秩检验进行组间比较。
中位手术时间和术中失血量分别为767.5分钟和2375克。12例患者（66.7%）出现围手术期并发症。5例患者（27.8%）在EBS后中位12.5个月出现肿瘤局部复发，其中4例切缘阳性。13例患者（72.2%）在EBS后中位21个月出现远处复发。远处复发后的估计中位生存期为20个月（95%置信区间，0.71 - 39.29个月）。未发现切缘状态与远处复发之间存在关联。总体而言，EBS后的2年、5年和10年生存率分别为72.2%、48.8%和27.1%。重要的是，实施EBS的时代并未影响肿瘤学结局。
我们的结果表明，即使EBS实现切缘阴性，其本身也无法预防进一步扩散，超过70%的患者在EBS后中位21个月出现了远处复发。这些结果在临床决策时应予以考虑并告知患者。
