寡转移和多转移脊柱肿瘤患者的生存、局部控制和健康相关生活质量：一项多中心、国际研究。
Survival, local control, and health-related quality of life in patients with oligometastatic and polymetastatic spinal tumors: A multicenter, international study.
机构信息
Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands.
出版信息
Cancer. 2019 Mar 1;125(5):770-778. doi: 10.1002/cncr.31870. Epub 2018 Nov 29.
BACKGROUND
The treatment of oligometastatic (≤5 metastases) spinal disease has trended toward ablative therapies, yet to the authors' knowledge little is known regarding the prognosis of patients presenting with oligometastatic spinal disease and the value of this approach. The objective of the current study was to compare the survival and clinical outcomes of patients with cancer with oligometastatic spinal disease with those of patients with polymetastatic (>5 metastases) disease.
METHODS
The current study was an international, multicenter, prospective study. Patients who were admitted to a participating spine center with a diagnosis of spinal metastases and who underwent surgical intervention and/or radiotherapy between August 2013 and May 2017 were included. Data collected included demographics, overall survival, local control, and treatment information including surgical, radiotherapy, and systemic therapy details. Health-related quality of life (HRQOL) measures included the EuroQOL 5 dimensions 3-level questionnaire (EQ-5D-3L), the 36-Item Short Form Health Survey (SF-36v2), and the Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ).
RESULTS
Of the 393 patients included in the current study, 215 presented with oligometastatic disease and 178 presented with polymetastatic disease. A significant survival advantage of 90.1% versus 77.3% at 3 months and 77.0% versus 65.1% at 6 months from the time of treatment was found for patients presenting with oligometastatic disease compared with those with polymetastatic disease. It is important to note that both groups experienced significant improvements in multiple HRQOL measures at 6 months after treatment, with no differences in these outcome measures noted between the 2 groups.
CONCLUSIONS
The treatment of oligometastatic disease appears to offer a significant survival advantage compared with polymetastatic disease, regardless of treatment choice. HRQOL measures were found to improve in both groups, demonstrating a palliative benefit for all treated patients.
背景
寡转移（≤5 个转移灶）脊柱疾病的治疗趋势倾向于采用消融疗法，但据作者所知，对于寡转移脊柱疾病患者的预后以及这种方法的价值知之甚少。本研究的目的是比较寡转移脊柱疾病患者与多转移（>5 个转移灶）疾病患者的生存和临床结局。
方法
本研究为国际性、多中心、前瞻性研究。纳入 2013 年 8 月至 2017 年 5 月期间在参与的脊柱中心就诊、接受手术干预和/或放疗的脊柱转移患者。收集的数据包括人口统计学资料、总生存、局部控制以及治疗信息，包括手术、放疗和系统治疗细节。健康相关生活质量（HRQOL）测量包括欧洲五维健康量表 3 级问卷（EQ-5D-3L）、36 项简明健康调查问卷（SF-36v2）和脊柱肿瘤研究组结局问卷（SOSGOQ）。
结果
本研究纳入 393 例患者，其中 215 例为寡转移疾病，178 例为多转移疾病。与多转移疾病患者相比，寡转移疾病患者在治疗后 3 个月时的 90.1%与 77.3%，6 个月时的 77.0%与 65.1%的生存率有显著优势。值得注意的是，两组患者在治疗后 6 个月时多个 HRQOL 指标均有显著改善，两组间这些结局指标无差异。
结论
与多转移疾病相比，无论治疗选择如何，寡转移疾病的治疗似乎都有显著的生存优势。两组患者的 HRQOL 均有改善，表明所有接受治疗的患者均有姑息治疗获益。
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