Dobran Mauro, Lisi Serena Vittoria, Di Rienzo Alessandro, Carrassi Erika, Capece Mara, Dorato Pasquale, di Somma Lucia Giovanna Maria, Iacoangeli Maurizio
Department of Neurosurgery, Università Politecnica delle Marche, Ancona, Italy.
Surg Neurol Int. 2022 Aug 19;13:363. doi: 10.25259/SNI_276_2022. eCollection 2022.
Surgical treatment of spinal metastases should be tailored to provide pain control, neurological deficit improvement, and vertebral stability with low operative morbidity and mortality. The aim of this study was to analyze the predictive value of some preoperative factors on overall survival in patients undergoing surgery for spinal metastases.
We retrospectively analyzed a consecutive series of 81 patients who underwent surgery for spinal metastases from 2015 and 2021 in the Clinic of Neurosurgery of Ancona (Italy). Data regarding patients' baseline characteristics, preoperative Karnofsky Performance Status Score (KPS), and Frankel classification grading system, histology of primary tumor, Tokuhashi revised and Tomita scores, Spine Instability Neoplastic Score, and Epidural Spinal Cord Compression Classification were collected. We also evaluated the interval time between the diagnosis of the primary tumor and the onset of spinal metastasis, the type of surgery, the administration of adjuvant therapy, postoperative pain and Frankel grade, and complications after surgery. The relationship between patients' overall survival and predictive preoperative factors was analyzed by the Kaplan-Meier method. For the univariate and multivariate analysis, the log-rank test and Cox regression model were used. ≤ 0.05 was considered as statistically significant.
After surgery, the median survival time was 13 months. In our series, the histology of the primary tumor ( < 0.001), the Tomita ( < 0.001) and the Tokuhashi revised scores ( < 0.001), the preoperative KPS ( < 0.001), the adjuvant therapy ( < 0.001), the postoperative Frankel grade ( < 0.001), and the postoperative pain improvement ( < 0.001) were significantly related to overall survival in the univariate analysis. In the multivariate analysis, the Tomita ( < 0.001), Tokuhashi revised scores ( < 0.001), and the adjuvant therapy were confirmed as independent prognostic factors.
These data suggest that patients with limited extension of primitive tumor and responsive to the adjuvant therapy are the best candidates for surgery with better outcome.
脊柱转移瘤的手术治疗应旨在控制疼痛、改善神经功能缺损并维持椎体稳定性，同时降低手术并发症发生率和死亡率。本研究旨在分析一些术前因素对接受脊柱转移瘤手术患者总生存期的预测价值。
我们回顾性分析了2015年至2021年在意大利安科纳神经外科诊所连续接受脊柱转移瘤手术的81例患者。收集了患者的基线特征、术前卡氏功能状态评分（KPS）、Frankel分级系统、原发肿瘤组织学、Tokuhashi修订评分和Tomita评分、脊柱不稳定肿瘤评分以及硬膜外脊髓压迫分级等数据。我们还评估了原发肿瘤诊断至脊柱转移发生的间隔时间、手术类型、辅助治疗的使用、术后疼痛和Frankel分级以及术后并发症。采用Kaplan-Meier法分析患者总生存期与术前预测因素之间的关系。单因素和多因素分析分别使用log-rank检验和Cox回归模型。P≤0.05被认为具有统计学意义。
术后中位生存时间为13个月。在我们的研究系列中，单因素分析显示原发肿瘤组织学（P<0.001）、Tomita评分（P<0.001）和Tokuhashi修订评分（P<0.001）、术前KPS（P<0.001）、辅助治疗（P<0.001）、术后Frankel分级（P<0.001）以及术后疼痛改善情况（P<0.001）与总生存期显著相关。多因素分析中，Tomita评分（P<0.001）、Tokuhashi修订评分（P<0.001）和辅助治疗被确认为独立预后因素。
这些数据表明，原发肿瘤扩展有限且对辅助治疗有反应的患者是手术效果更佳的最佳候选者。
