Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Radiation Oncology, Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada.
Spine J. 2021 Mar;21(3):492-499. doi: 10.1016/j.spinee.2020.10.017. Epub 2020 Oct 22.
Currently there is no prospective pain and health related quality of life (HRQOL) data of patients with potentially unstable spinal metastases who were treated with surgery ± radiation or radiation alone.
An international prospective cohort multicenter study of patients with potentially unstable spinal metastases, defined by a SINS score 7 to 12, treated with surgery ± radiation or radiotherapy alone was conducted. HRQOL was evaluated with the numeric rating scale (NRS) pain score, the SOSGOQ2.0, the SF-36, and the EQ-5D at baseline and 6, 12, 26, and 52 weeks after treatment.
A total of 136 patients were treated with surgery ± radiotherapy and 84 with radiotherapy alone. At baseline, surgically treated patients were more likely to have mechanical pain, a lytic lesion, a greater median Spinal Instability Neoplastic score, vertebral compression fracture, lower performance status, HRQOL, and pain scores. From baseline to 12 weeks post-treatment, surgically treated patients experienced a 3.0-point decrease in NRS pain score (95% CI -4.1 to -1.9, p<.001), and a 12.7-point increase in SOSGOQ2.0 score (95% CI 6.3-19.1, p<.001). Patients treated with radiotherapy alone experienced a 1.4-point decrease in the NRS pain score (95% CI -2.9 to 0.0, p=.046) and a 6.2-point increase in SOSGOQ2.0 score (95% CI -2.0 to 14.5, p=.331). Beyond 12 weeks, significant improvements in pain and HRQOL metrics were maintained up to 52-weeks follow-up in the surgical cohort, as compared with no significant changes in the radiotherapy alone cohort.
Patients treated with surgery demonstrated clinically and statistically significant improvements in pain and HRQOL up to 1-year postsurgery. Treatment with radiotherapy alone resulted in improved pain scores, but these were not sustained beyond 3 months and HRQOL outcomes demonstrated nonsignificant changes over time. Within the SINS potentially unstable group, distinct clinical profiles were observed in patients treated with surgery or radiotherapy alone.
目前尚无潜在不稳定脊柱转移患者接受手术+放疗或单纯放疗治疗后的前瞻性疼痛和健康相关生活质量（HRQOL）数据。
对 SINS 评分为 7-12 分的潜在不稳定脊柱转移患者进行了一项国际前瞻性队列多中心研究，这些患者接受了手术+放疗或单纯放疗治疗。使用数字评分量表（NRS）疼痛评分、SOSGOQ2.0、SF-36 和 EQ-5D 在治疗前和治疗后 6、12、26 和 52 周时评估 HRQOL。
共有 136 例患者接受手术+放疗治疗，84 例患者接受单纯放疗治疗。基线时，接受手术治疗的患者更有可能出现机械性疼痛、溶骨性病变、更高的中位脊柱不稳定肿瘤评分、椎体压缩性骨折、较低的功能状态、HRQOL 和疼痛评分。从基线到治疗后 12 周，手术治疗患者的 NRS 疼痛评分降低了 3.0 分（95%CI-4.1 至-1.9，p<.001），SOSGOQ2.0 评分增加了 12.7 分（95%CI6.3 至 19.1，p<.001）。单纯放疗患者的 NRS 疼痛评分降低了 1.4 分（95%CI-2.9 至 0.0，p=.046），SOSGOQ2.0 评分增加了 6.2 分（95%CI-2.0 至 14.5，p=.331）。超过 12 周后，手术组的疼痛和 HRQOL 指标持续改善，直至 52 周随访，而单纯放疗组则无明显变化。
接受手术治疗的患者在手术后 1 年内疼痛和 HRQOL 均有显著改善。单纯放疗可改善疼痛评分，但 3 个月后无持续改善，且 HRQOL 结果随时间无显著变化。在 SINS 潜在不稳定组中，手术或单纯放疗治疗的患者具有不同的临床特征。
