Department of Neurosurgery, Klinikum Rechts Der Isar, Technical University Munich School of Medicine, Ismaninger Str. 22, 81675, Munich, Germany.
Department of Hematology and Oncology, Technical University Munich School of Medicine, Munich, Germany.
Sci Rep. 2021 Apr 12;11(1):7988. doi: 10.1038/s41598-021-87121-1.
The management of patients with spinal metastases (SM) requires a multidisciplinary team of specialists involved in oncological care. Surgical management has evolved significantly over the recent years, which warrants reevaluation of its role in the oncological treatment concept. Any patient with a SM was screened for study inclusion. We report baseline characteristics, surgical procedures, complication rates, functional status and outcome of a large consecutive cohort undergoing surgical treatment according to an algorithm. 667 patients underwent 989 surgeries with a mean age of 65 years (min/max 20-94) between 2007 and 2018. The primary cancers mostly originated from the prostate (21.7%), breast (15.9%) and lung (10.0%). Surgical treatment consisted of dorsoventral stabilization in 69.5%, decompression without instrumentation in 12.5% and kyphoplasty in 18.0%. Overall survival reached 18.4 months (95% CI 9.8-26.9) and the median KPS increased by 10 within hospital stay. Surgical management of SMs should generally represent the first step of a conclusive treatment algorithm. The need to preserve long-term symptom control and biomechanical stability requires a surgical strategy currently not supported by level I evidence.
脊柱转移瘤（SM）患者的管理需要涉及肿瘤治疗的多学科专家团队。近年来，外科治疗已经有了显著的发展，这就需要重新评估其在肿瘤治疗概念中的作用。任何患有 SM 的患者都需要进行研究纳入筛选。我们根据算法报告了接受手术治疗的大量连续队列的基线特征、手术程序、并发症发生率、功能状态和结果。2007 年至 2018 年间，667 名患者接受了 989 次手术，平均年龄为 65 岁（最小/最大 20-94 岁）。主要癌症起源于前列腺（21.7%）、乳房（15.9%）和肺（10.0%）。手术治疗包括前后稳定 69.5%、无器械减压 12.5%和后凸成形术 18.0%。总体生存率达到 18.4 个月（95%CI9.8-26.9），住院期间 KPS 中位数增加了 10。脊柱转移瘤的外科治疗通常应代表明确治疗算法的第一步。需要长期保留症状控制和生物力学稳定性，这就需要一种目前没有 I 级证据支持的手术策略。
