Vreden National Medical Research Center of Traumatology and Orthopedics, Saint-Petersburg, Russia.
Saint-Petersburg State University, Saint-Petersburg, Russia.
Eur Spine J. 2023 Mar;32(3):1010-1020. doi: 10.1007/s00586-023-07548-0. Epub 2023 Jan 28.
Conditional survival (CS) provides a dynamic prediction of patient survival by incorporating the time an individual has already survived given their disease specific characteristics. The objective of the current study was to estimate CS among patients after surgery for spinal cord compression or spinal instability, as well as stratify CS according to relevant patient- and disease-related characteristics.
The clinical outcomes of 361 patients undergoing surgical management of metastatic spinal tumors were retrospectively analyzed. Stratification of this cohort according to disease and surgery-specific characteristics allowed for univariate and multivariate statistical analyses of our study population. Observed overall and conditional survival estimates were calculated by the Kaplan-Meier method.
12-month conditional survival in patients undergoing surgical management of metastatic spine tumors increased from 57% at baseline to 70% at 24 months following spine surgery. Overall survival (OS) was influenced by CCI grade, Katagiri tumor type, presence of lung metastasis, type of spine surgery, presence of postoperative systemic therapy and ambulatory status at follow-up. Analyses of OS and CS by prognostic strata were similar with exception of stratification by surgery type. Differences in survival between strata tend to converge over time. Unfavorable factors for OS appear to be less relevant after a period of 24 months following spine surgery.
Patients after surgery for metastatic tumors of the spine can expect a positive trend in conditional survival as survivorship increases. Even patients with a more severe disease can be encouraged with gains in conditional survival over time.
Level IV (retrospective cohort study).
条件生存（CS）通过纳入个体在给定疾病特异性特征下已经存活的时间，对患者的生存进行动态预测。本研究的目的是估计脊柱压迫或脊柱不稳定患者手术后的 CS，并根据相关患者和疾病相关特征对 CS 进行分层。
回顾性分析了 361 例接受转移性脊柱肿瘤手术治疗的患者的临床结果。根据疾病和手术特异性特征对该队列进行分层，允许对我们的研究人群进行单变量和多变量统计分析。通过 Kaplan-Meier 方法计算观察到的总体和条件生存估计值。
接受转移性脊柱肿瘤手术治疗的患者，在基线时 12 个月的条件生存率为 57%，在脊柱手术后 24 个月时增加到 70%。总生存（OS）受 CCI 分级、Katagiri 肿瘤类型、肺部转移、脊柱手术类型、术后全身治疗和随访时的活动状态的影响。OS 和 CS 的预后分层分析相似，除了手术类型分层。随着时间的推移，生存分层之间的差异趋于收敛。对 OS 不利的因素在脊柱手术后 24 个月后似乎不那么重要。
接受转移性脊柱肿瘤手术的患者，随着生存时间的延长，其条件生存预期呈积极趋势。即使是疾病更为严重的患者，随着时间的推移，条件生存也会有所提高。
IV 级（回顾性队列研究）。
