Shengjing Hospital of China Medical University, Heping District, Shenyang, China.
Pain Physician. 2021 Jan;24(1):E101-E109.
For palliative percutaneous vertebroplasty (PVP) for vertebral metastases, local bone destruction progression (LBDP) commonly occurs in the previously treated vertebrae. There were no studies regarding LBDP and its risk factors in previous reports, and there was no uniform evaluation method for the distribution of bone cement in the vertebrae.
We aimed to investigate the risk factors for LBDP after PVP for palliative treatments in patients with vertebral metastases. We also proposed that filling rates could be used as a simple evaluation method to detect vertebral metastases and explored its clinical significance.
This was a retrospective study.
A university hospital.
A total of 48 patients and 54 vertebrae that had received PVP as a palliative treatment for vertebral metastases were recruited between October 2012 to October 2019 from the Shengjing Hospital of the China Medical University. We collected and evaluated the data including age, gender, cement filled completely or not, cement dose used, the cement distribution score, time of LBDP, and so on, and the filing rate we proposed was also included.
This retrospective study divided 48 patients and 54 vertebrae into group A for those with an LBDP of less than 6 months (n = 41), and group B for those with an LBDP of 6 or more months (n = 13). The complete filling of bone cement and bone cement dose in group B was much higher than that in group A (2.85 ± 0.97 vs. 4.12 ± 1.77; P = 0.027), and the time of recurrent pain in group B was significantly higher compared with that in group A (8.46 ± 2.73 vs. 3.39 ± 1.63; P < 0.0001). There was a statistical difference in the Saliou score and filling rate between the 2 groups (11.77 ± 3.17 vs. 9.34 ± 3.28, P = 0.023; 0.752 ± 0.227 vs. 0.489 ± 0.161, P < 0.0001). Univariate logistic analysis showed that complete filling of cement, the cement dose, Saliou score, and filling rate were statistically significant predictors of LBDP occurring in less than 6 months. Multivariate logistic analysis showed that the filling rate was an independent predictor of patients with vertebral metastases developing LBDP in less than 6 months (odds ratio, < 0.001; 95% confidence interval, < 0.001-0.006; P = 0.0007). The cutoff value for the filling rate calculated from the receiver operating characteristic (ROC) curve analysis was 0.646, which could identify patients who had LBDP in less than 6 months of PVP with a sensitivity of 85.4% and specificity of 84.6%. The 6-month LBDP in the 0.646 or less ROC curve group was higher than that in the greater than 0.646 ROC curve group (97.22% vs. 55.56%, P < 0.0001).
The retrospective nature and small sample size were significant. Variation in the time and state of bone cement injected during all PVP procedures was a bias. There was no pathological diagnosis of all vertebral metastases.
The cement dose, complete filling of cement, Saliou score, and filling rate were factors negatively related to LBDP occurring in less than 6 months. Patients with lower filling rates are maybe more likely to have early LBDP compared with those with higher filling rates.
对于椎体转移瘤的姑息性经皮椎体成形术（PVP），先前治疗的椎体中通常会出现局部骨破坏进展（LBDP）。在之前的报告中，没有关于 LBDP 及其危险因素的研究，也没有用于评估椎体中骨水泥分布的统一方法。
我们旨在研究椎体转移瘤患者接受姑息性 PVP 治疗后 LBDP 的危险因素。我们还提出填充率可作为一种简单的评估方法来检测椎体转移瘤，并探讨其临床意义。
这是一项回顾性研究。
一所大学医院。
我们共招募了 48 名患者和 54 个椎体，这些患者在 2012 年 10 月至 2019 年 10 月期间因椎体转移瘤接受了 PVP 姑息性治疗。我们收集和评估了包括年龄、性别、骨水泥完全填充与否、骨水泥用量、骨水泥分布评分、LBDP 时间等数据，还包括我们提出的填充率。
这项回顾性研究将 48 名患者和 54 个椎体分为 A 组（LBDP ＜ 6 个月，n = 41）和 B 组（LBDP ≥ 6 个月，n = 13）。B 组的骨水泥完全填充和骨水泥用量明显高于 A 组（2.85 ± 0.97 比 4.12 ± 1.77；P = 0.027），B 组的复发性疼痛时间明显长于 A 组（8.46 ± 2.73 比 3.39 ± 1.63；P ＜ 0.0001）。两组间的 Saliou 评分和填充率存在统计学差异（11.77 ± 3.17 比 9.34 ± 3.28，P = 0.023；0.752 ± 0.227 比 0.489 ± 0.161，P ＜ 0.0001）。单因素 logistic 分析显示，骨水泥完全填充、骨水泥剂量、Saliou 评分和填充率是 LBDP ＜ 6 个月的统计学显著预测因素。多因素 logistic 分析显示，填充率是椎体转移瘤患者 LBDP ＜ 6 个月的独立预测因素（比值比，＜ 0.001；95%置信区间，＜ 0.001-0.006；P = 0.0007）。通过受试者工作特征（ROC）曲线分析计算得出的填充率临界值为 0.646，可识别出 PVP 后 6 个月内发生 LBDP 的患者，其灵敏度为 85.4%，特异性为 84.6%。0.646 或以下 ROC 曲线组的 6 个月 LBDP 高于 0.646 以上 ROC 曲线组（97.22%比 55.56%，P ＜ 0.0001）。
本研究为回顾性研究，样本量较小。所有 PVP 手术中骨水泥注入的时间和状态存在差异，这是一个偏倚。所有椎体转移瘤均未进行病理诊断。
骨水泥剂量、骨水泥完全填充、Saliou 评分和填充率是与 6 个月内发生 LBDP 相关的负性因素。与填充率较高的患者相比，填充率较低的患者可能更容易发生早期 LBDP。
