Department of Bone and Soft Tissue, the Affiliated Cancer Hospital of Zheng Zhou University, He Nan Cancer Hospital, Zheng Zhou, He Nan, China.
Department of Bone and Soft Tissue, the Affiliated Cancer Hospital of Zheng Zhou University, He Nan Cancer Hospital, Zheng Zhou, He Nan, China.
World Neurosurg. 2022 Sep;165:e373-e379. doi: 10.1016/j.wneu.2022.06.060. Epub 2022 Jun 22.
To analyze the efficacy and complications of spinal metastasis surgery for breast cancer; to understand the survival and the influencing factors; and to verify the predictive ability of the currently used spinal metastasis cancer survival prediction scoring system on 1 year postoperative survival.
A retrospective study was conducted of 54 patients with spinal metastases from breast cancer who underwent open surgery after multidisciplinary consultation in our hospital from January 2017 to October 2020. Patient demographic-related variables, breast cancer-related variables, spinal disorder-related variables, and treatment-related variables were collected. Survival curves were plotted using the Kaplan-Meier method, 1-way tests were performed using the log-rank method for factors that might affect prognosis, and candidate variables were included in the Cox model for multifactor analysis. The Tomita score, modified Tokuhashi score, modified Bauer score, and modified Katagiri score were examined by plotting the subject operating characteristic curve and calculating the area under the curve. The area under the curve was used to test the predictive ability of the SORG (Skeletal Oncology Research Group) original version, SORG line graph version, and SORG Web version for 1-year postoperative survival in patients with spinal metastases from breast cancer.
The average age was 51.3 ± 8.6 years in 54 patients. Twenty-one patients underwent vertebral body debulking surgery, 32 patients underwent palliative canal decompression, and 1 patient underwent vertebral en bloc resection, with an operative time of 229.3 ± 87.6 minutes and intraoperative bleeding of 1018.1 ± 931.1 mL. Postoperatively, the patient experienced significant pain relief and gradual recovery from nerve injury. Major surgical complications included cerebrospinal fluid leakage, secondary spinal cord injury, spinal tumor progression, and broken fixation. The mean survival was 32.2 months, including a 6-month survival of 90.7%, a 1-year survival of 77.8%, and a 2-year survival of 60.3%. Univariate analysis showed that preoperation with neurologic deficits, hormone-insensitive type, with brain metastases were potential risk factors for poor prognosis. Multifactorial analysis showed that hormone-insensitive type and concomitant brain metastasis were independent risk factors associated with poor prognosis. The SORG Web version had good ability to predict 1-year postoperative survival in patients with spinal metastases from breast cancer.
Spinal metastasis from breast cancer has good surgical efficacy, low postoperative recurrence rate, and relatively long survival after surgery. Patients with hormone-insensitive type, with brain metastasis, have a poor prognosis, and SORG Web version can predict patients' 1-year survival more accurately.
分析乳腺癌脊柱转移手术的疗效和并发症；了解生存情况和影响因素；验证目前使用的脊柱转移癌生存预测评分系统对术后 1 年生存的预测能力。
对 2017 年 1 月至 2020 年 10 月我院多学科会诊后行开放手术治疗的 54 例乳腺癌脊柱转移患者进行回顾性研究。收集患者人口统计学相关变量、乳腺癌相关变量、脊柱疾病相关变量和治疗相关变量。采用 Kaplan-Meier 法绘制生存曲线，对数秩检验分析可能影响预后的因素，Cox 多因素分析纳入候选变量。绘制受试者工作特征曲线并计算曲线下面积，对 Tomita 评分、改良 Tokuhashi 评分、改良 Bauer 评分和改良 Katagiri 评分进行评估。绘制 SORG（骨骼肿瘤研究组）原始版本、SORG 线图版本和 SORG Web 版本的受试者工作特征曲线，计算曲线下面积，评估 SORG 原始版本、SORG 线图版本和 SORG Web 版本对乳腺癌脊柱转移患者术后 1 年生存的预测能力。
54 例患者的平均年龄为 51.3±8.6 岁。21 例行椎体减压术，32 例行姑息性椎管减压术，1 例行整块椎体切除术，手术时间为 229.3±87.6 分钟，术中出血量为 1018.1±931.1ml。术后患者疼痛明显缓解，神经损伤逐渐恢复。主要手术并发症包括脑脊液漏、继发性脊髓损伤、脊柱肿瘤进展和固定断裂。平均生存时间为 32.2 个月，6 个月生存率为 90.7%，1 年生存率为 77.8%，2 年生存率为 60.3%。单因素分析显示，术前伴有神经功能缺损、激素不敏感型、伴脑转移是预后不良的潜在危险因素。多因素分析显示，激素不敏感型和伴脑转移是与预后不良相关的独立危险因素。SORG Web 版本对乳腺癌脊柱转移患者术后 1 年生存有较好的预测能力。
乳腺癌脊柱转移手术疗效好，术后复发率低，生存时间相对较长。激素不敏感型、伴脑转移患者预后不良，SORG Web 版本能更准确地预测患者的 1 年生存率。
