Department of Surgical and Perioperative Sciences, Orthopaedics, Umeå University, Umeå, Sweden.
Division of Neuroradiology, Diagnostic Centre for Imaging and Functional Medicine, Lund University, Skåne University Hospital, Lund, Sweden.
Spine (Phila Pa 1976). 2021 Apr 15;46(8):550-558. doi: 10.1097/BRS.0000000000003835.
We retrospectively analyzed Spinal Instability Neoplastic Score (SINS) in 110 patients with prostate cancer operated for metastatic spinal cord compression (MSCC).
We aimed to investigate the association between SINS and clinical outcomes after surgery for MSCC in patients with prostate cancer.
The SINS is a useful tool for assessing tumor-related spinal instability, but its prognostic value regarding survival and neurological outcome is still controversial.
We analyzed 110 consecutive patients with prostate cancer who underwent surgery for MSCC. The patients were categorized according to their SINS. Patients with castration-resistant prostate cancer (CRPC, n = 84) and those with hormone-naïve disease (n = 26) were analyzed separately.
In total, 106 of 110 patients met the SINS criteria for potential instability or instability (scores 7-18). The median SINS was 10 (range 6-15) for patients with CRPC and 9 (7-16) for hormone-naïve patients. In the CRPC group, the SINS was classified as stable (score 0-6) in 4 patients, as potentially unstable (score 7-12) in 70 patients, and as unstable (score 13-18) in 10 patients. In the hormone-naïve group, 22 patients met the SINS criteria for potential instability and 4 patients for instability. There was no statistically significant difference in the overall risk for death between the SINS potentially unstable and unstable categories (adjusted hazard ratio 1.3, P = 0.4), or in the risk of loss of ambulation 1 month after surgery (adjusted odds ratio 1.4, P = 0.6).
The SINS is helpful in assessing spinal instability when selecting patients for surgery, but it does not predict survival or neurological outcomes. Patients with a potential spinal instability benefit equally from surgery for MSCC as do patients with spinal instability.Level of Evidence: 3.
我们回顾性分析了 110 例前列腺癌合并转移性脊髓压迫症（MSCC）患者的脊柱不稳定肿瘤评分（SINS）。
探讨前列腺癌合并 MSCC 患者的 SINS 与术后临床结果的关系。
SINS 是一种评估肿瘤相关性脊柱不稳定的有用工具，但关于其对生存和神经功能结局的预后价值仍存在争议。
我们分析了 110 例连续接受 MSCC 手术的前列腺癌患者。根据 SINS 将患者进行分类。对去势抵抗性前列腺癌（CRPC，n=84）和激素初治疾病（n=26）患者分别进行分析。
110 例患者中，106 例符合潜在不稳定或不稳定的 SINS 标准（评分 7-18）。CRPC 患者的 SINS 中位数为 10（范围 6-15），激素初治患者为 9（7-16）。在 CRPC 组中，4 例患者 SINS 为稳定（评分 0-6），70 例患者为潜在不稳定（评分 7-12），10 例患者为不稳定（评分 13-18）。在激素初治组中，22 例患者 SINS 为潜在不稳定，4 例患者为不稳定。SINS 潜在不稳定与不稳定亚组之间的总死亡风险无统计学差异（校正后的危险比 1.3，P=0.4），术后 1 个月丧失行走能力的风险也无统计学差异（校正后的比值比 1.4，P=0.6）。
SINS 有助于评估脊柱不稳定情况，从而选择手术患者，但它不能预测生存或神经功能结局。潜在脊柱不稳定患者从 MSCC 手术中获益与脊柱不稳定患者相同。
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