Nakajima Hideaki, Watanabe Shuji, Honjoh Kazuya, Izubuchi Yuya, Watanabe Yumiko, Tanaka Takaaki, Matsumine Akihiko
Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan.
Cancers (Basel). 2022 Aug 10;14(16):3868. doi: 10.3390/cancers14163868.
Prediction of prognosis is a key factor in therapeutic decision making due to recent the development of therapeutic options for spinal metastases. The aim of the study was to examine predictive scoring systems and identify prognostic factors for 6-month mortality after palliative surgery. The participants were 75 patients with spinal metastases who underwent palliative surgery and had a minimum follow-up period of 1 year. Associations of actual survival with categories based on the revised Tokuhashi score and new Katagiri score were evaluated. Univariate and multivariate analyses were performed to identify prognostic factors for 6-month mortality after palliative surgery. The median actual survival period was longer than those predicted using the scoring systems. However, 21.3% of patients died of cancers within 6 months after surgery. A higher CRP/albumin ratio (odds ratio: 0.39; cut-off 0.409) and absence of postoperative adjuvant therapy (odds ratio: 7.15) were independent risk factors for 6-month mortality. There was no association of mortality with primary site, severity of sarcopenia, or other biomarkers. These results suggest that careful consideration is needed to determine whether palliative surgery is the best option for patients with a high preoperative CRP/albumin ratio and/or absence of postoperative adjuvant therapy, regardless of predictions made from scoring systems.
由于近期脊柱转移瘤治疗方案的发展，预后预测是治疗决策中的关键因素。本研究的目的是检验预测评分系统，并确定姑息性手术后6个月死亡率的预后因素。研究对象为75例接受姑息性手术且最短随访期为1年的脊柱转移瘤患者。评估了基于修订的Tokuhashi评分和新的Katagiri评分的实际生存与分类之间的关联。进行单因素和多因素分析以确定姑息性手术后6个月死亡率的预后因素。实际生存期中位数长于使用评分系统预测的生存期。然而，21.3%的患者在术后6个月内因癌症死亡。较高的CRP/白蛋白比值（比值比：0.39；临界值0.409）和未进行术后辅助治疗（比值比：7.15）是6个月死亡率的独立危险因素。死亡率与原发部位、肌肉减少症严重程度或其他生物标志物无关。这些结果表明，无论评分系统的预测如何，对于术前CRP/白蛋白比值高和/或未进行术后辅助治疗的患者，在确定姑息性手术是否为最佳选择时需要谨慎考虑。
