脊柱转移瘤姑息性手术后新片冈评分系统中的预后因素

Prognostic Factors in the New Katagiri Scoring System After Palliative Surgery for Spinal Metastasis.

作者信息

Kobayashi Kazuyoshi, Ando Kei, Nakashima Hiroaki, Sato Koji, Kanemura Tokumi, Yoshihara Hisatake, Hirasawa Atsuhiko, Kato Fumihiko, Ishiguro Naoki, Imagama Shiro

机构信息

Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan.

Department of Orthopaedic Surgery, Japanese Red Cross Nagoya Daini Hospital, Showa-ku, Nagoya, Japan.

出版信息

Spine (Phila Pa 1976). 2020 Jul 1;45(13):E813-E819. doi: 10.1097/BRS.0000000000003415.

DOI:10.1097/BRS.0000000000003415

PMID:32044810

Abstract

STUDY DESIGN

Retrospective study.

OBJECTIVE

The purpose of the study was to examine survival after surgery for a metastatic spinal tumor using prognostic factors in the new Katagiri score.

SUMMARY OF BACKGROUND DATA

Surgery for spinal metastasis can improve quality of life and facilitate treatment of the primary cancer. However, choice of therapy requires identification of prognostic factors for survival, and these may change over time due to treatment advances. The new Katagiri score for the prognosis of skeletal metastasis includes classification of the primary tumor site and the effects of chemotherapy and hormonal therapy.

METHODS

The subjects were 201 patients (127 males, 74 females) who underwent surgery for spinal metastases at six facilities in the Nagoya Spine Group. Age at surgery, gender, follow-up, metastatic spine level, primary cancer, new Katagiri score (including primary site, visceral metastasis, laboratory data, performance status (PS), and chemotherapy) and survival were obtained from a prospectively maintained database.

RESULTS

Posterior decompression (n = 29) and posterior decompression and fixation with instrumentation (n = 182) were performed at a mean age of 65.9 (range, 16-85) years. Metastasis was present in the cervical (n = 19, 10%), thoracic (n = 155, 77%), and lumbar (n = 26, 13%) spine, and sacrum (n = 1, 1%). In multivariate analysis, moderate growth (HR 2.95, 95% CI, 1.27-7.89, P < 0.01) and rapid growth (HR 4.71, 95% CI, 2.78-12.31, P < 0.01) at the primary site; nodular metastasis (HR 1.53, 95% CI, 1.07-3.85, P < 0.01) and disseminated metastasis (HR 2.94, 95% CI, 1.33-5.42, P < 0.01); and critical laboratory data (HR 3.15, 95% CI, 2.06-8.36, P < 0.01), and poor PS (HR 2.83, 95% CI, 1.67-4.77, P < 0.01) were significantly associated with poor survival.

CONCLUSION

Accurate prognostic factors are important in deciding the treatment strategy in patients with spinal metastasis, and our identification of these factors may be useful for these patients.

LEVEL OF EVIDENCE

摘要

研究设计

回顾性研究。

目的

本研究旨在利用新的片桐评分中的预后因素来研究转移性脊柱肿瘤手术后的生存率。

背景数据总结

脊柱转移瘤手术可改善生活质量并便于原发性癌症的治疗。然而，治疗方案的选择需要确定生存的预后因素，并且由于治疗进展，这些因素可能随时间而变化。用于骨骼转移预后的新片桐评分包括原发性肿瘤部位的分类以及化疗和激素治疗的效果。

方法

研究对象为201例患者（男性127例，女性74例），他们在名古屋脊柱研究组的六个机构接受了脊柱转移瘤手术。从一个前瞻性维护的数据库中获取手术年龄、性别、随访情况、转移脊柱节段、原发性癌症、新片桐评分（包括原发部位、内脏转移、实验室数据、体能状态（PS）和化疗）以及生存率。

结果

平均年龄65.9岁（范围16 - 85岁）时进行了后路减压术（n = 29）和后路减压及器械固定术（n = 182）。转移发生在颈椎（n = 19，10%）、胸椎（n = 155，77%）、腰椎（n = 26，13%）和骶骨（n = 1，1%）。在多变量分析中，原发部位的中度生长（风险比[HR] 2.95，95%置信区间[CI]，1.27 - 7.89，P < 0.01）和快速生长（HR 4.71，95% CI，2.78 - 12.31，P < 0.01）；结节状转移（HR 1.53，95% CI，1.07 - 3.85，P < 0.01）和弥漫性转移（HR 2.94，95% CI，1.33 - 5.42，P < 0.01）；以及关键实验室数据（HR 3.15，95% CI，2.06 - 8.36，P < 0.01）和较差的PS（HR 2.83，95% CI，1.67 - 4.77）与较差的生存率显著相关。