Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
Department of Neurologic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, USA.
J Neurooncol. 2019 Apr;142(2):347-354. doi: 10.1007/s11060-019-03105-2. Epub 2019 Jan 17.
Intramedullary spinal cord metastases (ISCMs) are rare lesions affecting the spinal cord in patients with disseminated malignancy. Today, due to increased survival, these lesions are more frequently diagnosed. Literature on survival and neurologic outcomes is sparse. Herein, we describe a single institutional case series on ISCMs reported to date in the English literature.
We retrospectively analyzed the medical records of patients diagnosed with intramedullary metastatic lesions at our institution between 1997 and 2016. We analyzed different approaches to management and factors influencing survival and neurologic outcomes.
A total of 70 patients (86 lesions) were analyzed. Most lesions were found in thoracic spinal cord (50%) followed by cervical (34%) and conus medullaris (14%). Mean age at diagnosis was 55.6 ± 10.6 years with 60% (n = 42) being females. Median survival was 104.5 days (range 1-888 days). Twenty-three patients (33%) received conservative management, 39 (56%) received palliative radiotherapy, whereas 8 (11%) underwent surgery with one patient receiving only a biopsy. Age, sex, presence of concomitant brain and other systemic metastasis didn't influence survival. Patients with solitary metastases had longer survival compared to multiple lesions (3.6 vs. 2.2 months, p = 0.01). In patients with solitary lesions without brain metastasis, surgical resection was associated with significantly longer survival (6 months vs. 3 months, p = 0.02).
The overall survival in patients with intramedullary metastasis remains poor. Surgical management may contribute to improved survival and neurologic outcomes in selected patients. Intramedullary metastasis may have a greater role on overall survival compared to systemic metastatic burden.
脊髓髓内转移（ISCM）是一种罕见的病变，发生于有播散性恶性肿瘤的患者的脊髓。如今，由于生存期的延长，这些病变的诊断更为频繁。有关生存和神经结局的文献很少。在此，我们描述了迄今为止在英文文献中报道的单一机构 ISCM 病例系列。
我们回顾性分析了我院在 1997 年至 2016 年间诊断为脊髓内转移性病变的患者的病历。我们分析了不同的管理方法以及影响生存和神经结局的因素。
共分析了 70 例患者（86 个病灶）。大多数病变位于胸段脊髓（50%），其次为颈段（34%）和圆锥部（14%）。诊断时的平均年龄为 55.6±10.6 岁，其中 60%（n=42）为女性。中位生存期为 104.5 天（范围 1-888 天）。23 例（33%）患者接受保守治疗，39 例（56%）患者接受姑息性放疗，8 例（11%）患者接受手术治疗，其中 1 例仅接受活检。年龄、性别、是否合并脑转移和其他全身转移并不影响生存。单发转移患者的生存时间长于多发病变患者（3.6 个月比 2.2 个月，p=0.01）。在无脑转移的单发病变患者中，手术切除与生存时间显著延长相关（6 个月比 3 个月，p=0.02）。
脊髓内转移患者的总体生存率仍然较差。手术治疗可能有助于改善选择患者的生存和神经结局。与全身转移负担相比，脊髓内转移对总体生存率的影响可能更大。
