Schoenfeld Andrew J, Ferrone Marco L, Schwab Joseph H, Blucher Justin A, Barton Lauren B, Harris Mitchel B, Kang James D
Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, United States.
Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, United States.
Clin Neurol Neurosurg. 2019 Jun;181:98-103. doi: 10.1016/j.clineuro.2019.04.009. Epub 2019 Apr 22.
To assess the impact of surgical intervention on survival, ambulatory capacity, complications and readmissions following treatment for lumbar metastases.
We identified all adult patients treated for lumbar metastases between 2005-2017. To limit the potential for inherent bias to influence determinations, we used principal component analysis to identify confounders to be included in multivariable testing. Multivariable logistic regression was performed, followed by Bayesian analysis to generate conservative estimates of effect size and 95% confidence intervals (CI). In a sensitivity test, analyses were repeated in a population where patients who died before they could initiate treatment were excluded.
In the period under study, we identified 571 patients who met inclusion criteria. Twenty-one percent of the cohort received a surgical intervention. Bayes regression indicated surgical intervention was independently associated with decreased mortality at 6-months (odds ratio [OR] 0.49; 95% CI 0.34, 0.68) and 1-year (OR 0.63; 95% CI 0.51, 0.76), along with lower odds of being non-ambulatory at 6-months following presentation (OR 0.29; 95% CI 0.18, 0.45). Surgery was also associated with increased odds of complications (OR 1.60; 95% CI 1.24, 2.06) and readmissions (OR 1.37; 95% CI 1.09, 1.72). Numerous clinical characteristics were found to be associated with the outcomes of interest including serum albumin, lung metastases and vertebral body collapse.
Given the favorable outcomes associated with the incorporation of surgery as a component of treatment, we believe that such interventions may be considered part of the treatment approach in patients with lumbar metastases.
评估手术干预对腰椎转移瘤治疗后的生存、活动能力、并发症及再入院情况的影响。
我们确定了2005年至2017年间所有接受腰椎转移瘤治疗的成年患者。为限制内在偏倚对判定结果的潜在影响，我们采用主成分分析来确定多变量测试中要纳入的混杂因素。进行多变量逻辑回归分析，随后进行贝叶斯分析以生成效应大小的保守估计值和95%置信区间（CI）。在一项敏感性测试中，对排除了在开始治疗前死亡患者的人群重复进行分析。
在研究期间，我们确定了571例符合纳入标准的患者。该队列中有21%的患者接受了手术干预。贝叶斯回归表明，手术干预与6个月时死亡率降低独立相关（比值比[OR] 0.49；95% CI 0.34，0.68）以及1年时死亡率降低独立相关（OR 0.63；95% CI 0.51，0.76），同时在就诊后6个月时非活动状态的几率也较低（OR 0.29；95% CI 0.18，0.45）。手术还与并发症几率增加（OR 1.60；95% CI 1.24，2.06）和再入院几率增加（OR 1.37；95% CI 1.09，1.72）相关。发现许多临床特征与感兴趣的结局相关，包括血清白蛋白、肺转移和椎体塌陷。
鉴于将手术作为治疗组成部分具有良好的结局，我们认为此类干预可被视为腰椎转移瘤患者治疗方法的一部分。
