Department of Neurosurgery, Hospital Bretonneau, Tours.
Department of Neurosurgery, Clairval Private Hospital, Ramsay Generale de Sante, Marseille.
Spine (Phila Pa 1976). 2023 Apr 1;48(7):476-483. doi: 10.1097/BRS.0000000000004568. Epub 2022 Dec 28.
This study used a French prospective national multi-center database of patients with spine metastasis (SpM).
The main challenge was to clarify if SpM patients presenting poor ECOG-PS could benefit from a surgical intervention.
Spine metastases (SpM) are debilitating lesions commonly found in the evolution of cancer. At present, patients with poor ECOG-PS do not benefit from surgical care.
Between 2014 and 2017, 176 SpM patients with poor initial ECOG-PS (3 or 4) were identified.
The median overall survival of patients was 2.1 months (SD 0.2). Seventy-one patients (40.3%) underwent surgery: for 49 patients (27.8%) the intervention consisted of a simple decompression and for 22 patients (12.5%) the previous was associated with an osteosynthesis. Patients who underwent surgery demonstrated significantly longer median overall survival than those who did not: 3.5 months (SD 0.4) versus 1.6 (SD 0.2) ( P <0.0001). No significant differences between operated/nonoperated patients were noted concerning median age (66.4 vs. 64.2 y, P =0.897), the median number of SpM (4.1 vs. 4.2, P =0.374), ECOG-PS 4 ratio (41.6 vs. 39.3%, P =0.616), or for primary tumors ( P =0.103). Patients who underwent surgery statistically improved their neurological impairment according to the Frankel score: 5/11 (45.4%) from A to C, 5/17 (29.4%) from B to C or D, 6/11 (54.5%) from C to D and 2/4 (50%). Twelve patients (16.9%) presented a postoperative complication.
Patients with poor ECOG-PS could benefit from surgery. Even though survival gain is small, it permits the preservation of their neurological function. By making ambulation possible, pain is decreased during the last months of their lives.
本研究使用了法国前瞻性多中心脊柱转移瘤（SpM）患者数据库。
主要挑战是明确初始 ECOG-PS 较差的 SpM 患者是否受益于手术干预。
脊柱转移瘤（SpM）是癌症进展中常见的使人虚弱的病变。目前，ECOG-PS 较差的患者不能从手术治疗中获益。
2014 年至 2017 年间，共确定了 176 例初始 ECOG-PS 较差（3 或 4）的 SpM 患者。
患者的中位总生存期为 2.1 个月（标准差 0.2）。71 例患者（40.3%）接受了手术：49 例患者（27.8%）的干预措施为单纯减压，22 例患者（12.5%）的干预措施为内固定。接受手术的患者的中位总生存期明显长于未接受手术的患者：3.5 个月（标准差 0.4）比 1.6 个月（标准差 0.2）（P<0.0001）。手术/非手术患者的中位年龄（66.4 岁对 64.2 岁，P=0.897）、脊柱转移瘤数量（4.1 对 4.2，P=0.374）、ECOG-PS 4 比例（41.6%对 39.3%，P=0.616）或原发肿瘤（P=0.103）无显著差异。根据 Frankel 评分，接受手术的患者的神经损伤得到了统计学改善：11 例中有 5 例（45.4%）从 A 级提高到 C 级，17 例中有 5 例（29.4%）从 B 级提高到 C 级或 D 级，11 例中有 6 例（54.5%）从 C 级提高到 D 级，4 例中有 2 例（50%）从 A 级提高到 C 级。12 例患者（16.9%）发生术后并发症。
ECOG-PS 较差的患者可从手术中获益。尽管生存获益较小，但可保留其神经功能。通过使患者能够行走，可减少其生命最后几个月的疼痛。
