Department of Orthopedic Surgery, Tianjin First Central Hospital, 24 Fukang Rd, Nankai District, Tianjin, 300192, China.
Graduate School, Tianjin Medical University, Tianjin, 300070, China.
BMC Musculoskelet Disord. 2020 Jun 17;21(1):388. doi: 10.1186/s12891-020-03412-0.
To guide the selection of treatments for spinal metastases, the expected survival time is one of the most important determinants. Few scoring systems are fully applicable for spinal metastasis secondary to prostate cancer (PCa). This study aimed to identify the independent factors to predict the overall survival (OS) of patients with spinal metastases from PCa.
The PubMed, Embase and CENTRAL were retrieved by two reviewers independently, to identify studies analyzed the prognostic effect of different factors in spinal metastasis from PCa. A systematic review and quantitative meta-analysis was conducted with hazard ratio (HR) and 95% confidence interval (95%CI) as the effect size.
A total of 12 retrospective cohort studies (1566 patients) were eligible for qualitative synthesis and 10 for quantitative meta-analyses. The OS was significantly influenced by performance status, visceral metastasis, ambulatory status and time from PCa diagnosis in more than half of the available studies. The meta-analyses demonstrated that OS was significantly influenced by visceral metastasis (HR = 2.24, 95%CI:1.53-3.27, p < 0.001), pre-treatment ambulatory status (HR = 2.64, 95%CI:1.82-3.83, p < 0.001), KPS (HR = 4.45, 95%CI:2.01-9.85, p < 0.001), ECOG (HR = 2.96, 95%CI:2.02-4.35, p < 0.001), extraspinal bone metastasis (HR = 2.04, 95%CI:1.13-3.68, p = 0.018), time developing motor deficit (HR = 1.57, 95%CI:1.30-1.88, p < 0.001) and time from PCa diagnosis (HR = 1.37, 95%CI:1.17-1.59, p < 0.001).
Visceral metastasis, ambulatory status, extraspinal bone metastasis, performance status, time developing motor deficit and time interval from primary tumor diagnosis were significantly associated with the OS for spinal metastasis from PCa. When selecting the treatment modality, clinicians should fully consider the patients' systematic status based on all potential prognostic factors.
I Meta-analysis.
为了指导脊柱转移瘤的治疗选择，预期生存时间是最重要的决定因素之一。很少有评分系统完全适用于前列腺癌（PCa）引起的脊柱转移。本研究旨在确定独立因素，以预测 PCa 脊柱转移患者的总生存期（OS）。
两位评审员独立检索了 PubMed、Embase 和 CENTRAL，以确定分析不同因素对 PCa 脊柱转移瘤预后影响的研究。使用风险比（HR）和 95%置信区间（95%CI）作为效应大小进行系统评价和定量荟萃分析。
共有 12 项回顾性队列研究（1566 例患者）适合定性综合分析，10 项适合定量荟萃分析。超过一半的研究表明，患者的一般状况、内脏转移、活动能力状态和从 PCa 诊断到出现症状的时间对 OS 有显著影响。荟萃分析表明，OS 显著受内脏转移（HR=2.24，95%CI：1.53-3.27，p<0.001）、治疗前活动能力状态（HR=2.64，95%CI：1.82-3.83，p<0.001）、KPS（HR=4.45，95%CI：2.01-9.85，p<0.001）、ECOG（HR=2.96，95%CI：2.02-4.35，p<0.001）、脊柱外骨转移（HR=2.04，95%CI：1.13-3.68，p=0.018）、出现运动功能障碍的时间（HR=1.57，95%CI：1.30-1.88，p<0.001）和从 PCa 诊断到出现症状的时间（HR=1.37，95%CI：1.17-1.59，p<0.001）的影响。
内脏转移、活动能力状态、脊柱外骨转移、一般状况、出现运动功能障碍的时间和从原发肿瘤诊断到出现症状的时间与 PCa 脊柱转移的 OS 显著相关。在选择治疗方式时，临床医生应根据所有潜在的预后因素，充分考虑患者的全身状况。
I 级荟萃分析。
