Nakanishi Kazuo, Uchino Kazuya, Watanabe Seiya, Iba Hideaki, Hasegawa Toru
Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, Okayama, Japan.
Spine Surg Relat Res. 2020 Mar 19;4(3):223-228. doi: 10.22603/ssrr.2019-0105. eCollection 2020.
The cancer board system employed at many hospitals and treatment centers involves multidisciplinary healthcare teams, including physicians, and the timing of treatment generally follows that of a consultation model. Thus, it is difficult to detect spinal metastases using the current implementation of the cancer board system, which can lead to delays in treatment. A new multidisciplinary treatment strategy for patients with metastatic spinal tumors was designed, and 745 patients were treated based on this strategy.
In the first 5 years using the liaison treatment approach, 745 patients were diagnosed with metastatic spinal tumor. Tumors were discovered before a skeletal-related event (SRE) in 704 patients and after an SRE in 41 patients. We conducted our analysis in two patient groups: those with and without an SRE at the time of treatment initiation.
In most patients, the average spinal instability neoplastic score was 5.2, which indicates that we were able to detect the spinal tumor before a significant breakdown of the spinal support system. Ninety-five percent of patients were classified according to the Frankel grade classification during their initial diagnosis, and many patients initially underwent treatment before the onset of paralysis. Of patients with an SRE, 33% were Frankel grade E, indicating that approximately half were paralyzed at initial diagnosis. The median survival duration was prolonged by approximately 9 months in patients without an SRE compared with those with an SRE.
Orthopedic spine surgeons are responsible for maintaining activities of daily living, improving quality of life, and prolonging life expectancy in patients with metastatic spinal tumors. The results of this study revealed that the liaison treatment system for metastatic spinal tumors has made it possible to successfully prevent SREs without neurological deficits and to prolong survival.
许多医院和治疗中心采用的癌症委员会系统涉及多学科医疗团队，包括医生，治疗时间通常遵循会诊模式。因此，使用当前实施的癌症委员会系统很难检测到脊柱转移瘤，这可能导致治疗延误。我们设计了一种针对转移性脊柱肿瘤患者的新的多学科治疗策略，并基于该策略对745例患者进行了治疗。
在采用联络治疗方法的前5年中，745例患者被诊断为转移性脊柱肿瘤。704例患者在发生骨相关事件（SRE）之前发现肿瘤，41例患者在发生SRE之后发现肿瘤。我们在两个患者组中进行了分析：治疗开始时有无SRE的患者。
在大多数患者中，平均脊柱不稳定肿瘤评分是5.2，这表明我们能够在脊柱支撑系统严重受损之前检测到脊柱肿瘤。95%的患者在初次诊断时根据Frankel分级分类，许多患者在瘫痪发作之前就开始接受治疗。在发生SRE的患者中，33%为Frankel E级，这表明大约一半患者在初次诊断时已瘫痪。与发生SRE的患者相比，未发生SRE的患者中位生存期延长了约9个月。
骨科脊柱外科医生负责维持转移性脊柱肿瘤患者的日常生活活动、提高生活质量并延长预期寿命。本研究结果表明，转移性脊柱肿瘤的联络治疗系统已成功预防了无神经功能缺损的SRE并延长了生存期。
