de Andrade Erion Junior, Formentin Cleiton, Martins Samilly Conceição Maia, Maeda Fernando Luis, Turolo Otávio, de Vasconcelos Victor Leal, Ghizoni Enrico, Tedeschi Helder, Joaquim Andrei Fernandes
Department of Neurology, State University of Campinas (UNICAMP), Campinas, SP, Brazil.
Department of Orthopedics, State University of Campinas (UNICAMP), Campinas, SP, Brazil.
J Craniovertebr Junction Spine. 2020 Jul-Sep;11(3):210-216. doi: 10.4103/jcvjs.JCVJS_72_20. Epub 2020 Aug 14.
Despite the various treatment protocols available, survival evaluation is a fundamental criterion for the definition of surgical management; there are still many inconsistencies in the literature on this topic, especially in terms of the value of surgery and its morbidity in patients with very short survival.
The objective was to analyze the association of clinical, oncological, and surgical factors in the survival of patients undergoing spinal surgery for spinal metastases (SM).
A retrospective cohort of forty patients who were surgically treated at our institution for SM between 2010 and 2018 were included in the study. We applied the prognostic scales of Tomita and Tokuhashi in each patient and evaluated the systemic status using Karnofsky Performance Scale (KPS) and Eastern Cooperative Oncology Group Performance Scale. Survival rate in months was estimated using the Kaplan-Meier curve, with death considered as primary outcome and, for the evaluation of the association between the variables, the Chi-square test, Fisher's exact test, or Fisher-Freeman-Halton test was applied for better survival. The level of statistical significance was considered as 5% ( ≤ 0.05).
The mean survival was 8.4 months. Patients with KPS <70 had a mean survival of 6.36 months, while those with KPS >70 had a mean survival of 14.48 months ( = 0.04). The mean survival of patients classified as ECOG 2 was 7.05 months (95% confidence interval [CI]: 3.4-10.7), and that of patients classified as ECOG 3 and 4 was 1.24 months (95% CI: 0.8-1.59). The mean survival rate among the patients with unresectable metastases in other organs was 6.3 months (95% CI: 3.9-8.9), while the survival rate of those who did not have metastases was 13.8 months (95% CI: 10.0-17.68; = 0.022).
Survival was associated with the preoperative functional status defined by the KPS and ECOG scales and with the presence of nonresectable visceral metastases.
尽管有多种可用的治疗方案，但生存评估仍是确定手术治疗的基本标准；关于这一主题的文献中仍存在许多不一致之处，特别是在生存期极短的患者中手术的价值及其发病率方面。
分析接受脊柱转移瘤（SM）脊柱手术患者生存情况与临床、肿瘤学及手术因素之间的关联。
本研究纳入了2010年至2018年间在我院接受SM手术治疗的40例患者的回顾性队列。我们对每位患者应用了富田和德桥预后量表，并使用卡诺夫斯基功能状态量表（KPS）和东部肿瘤协作组功能状态量表评估全身状况。采用Kaplan-Meier曲线估计以月为单位的生存率，将死亡视为主要结局，为评估变量之间的关联，应用卡方检验、Fisher精确检验或Fisher-Freeman-Halton检验以获得更好的生存率。统计学显著性水平设定为5%（≤0.05）。
平均生存期为8.4个月。KPS＜70的患者平均生存期为6.36个月，而KPS＞70的患者平均生存期为14.48个月（P = 0.04）。被归类为东部肿瘤协作组2级的患者平均生存期为7.05个月（95%置信区间[CI]：3.4 - 10.7），而被归类为东部肿瘤协作组3级和4级的患者平均生存期为1.24个月（95% CI：0.8 - 1.59）。其他器官存在不可切除转移瘤的患者平均生存率为6.3个月（95% CI：3.9 - 8.9），而无转移瘤患者的生存率为13.8个月（95% CI：10.0 - 17.68；P = 0.022）。
生存情况与KPS和东部肿瘤协作组量表所定义的术前功能状态以及不可切除的内脏转移瘤的存在有关。
