Miyaji Yoshiyuki, Nakanishi Kazuo, Yamamoto Akira, Yoden Eisaku, Tokiya Ryuji, Okawaki Makoto, Inubushi Masayuki, Katsui Kuniaki
Department of Urology, Kawasaki Medical School, Kurashiki, Japan.
Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, Kurashiki, Japan.
Cancer Diagn Progn. 2023 Jul 3;3(4):449-456. doi: 10.21873/cdp.10238. eCollection 2023 Jul-Aug.
BACKGROUND/AIM: To evaluate the Spinal Instability Neoplastic Score (SINS) for prediction of survival in patients with spinal column metastasis of castration-resistant prostate cancer (CRPC).
A retrospective study of spinal instability was performed in patients with CRPC using SINS. Overall survival was evaluated starting from the time of SINS evaluation. The subjects were 42 patients with CRPC among 261 cases diagnosed with metastatic spinal tumors by radiologists, among 42,152 cases that underwent a body computed tomography scan at Kawasaki Medical School Hospital within 32 months from December 2013 to July 2016.
The median age was 78 (range=55-91 years), the median prostate-specific antigen (PSA) level at SINS evaluation was 42.1 (0.1-3,121.6) ng/ml, and 11 patients had visceral metastasis. The median periods from diagnosis of bone metastasis and development of CRPC to SINS evaluation were 17 (0-158) and 20 (0-149) months, respectively. The spine was stable in 32 cases (group S) and potentially unstable or unstable in 10 (24%) (group U). The median observation period was 17.5 (0-83) months and 36 patients died. The median survival period after SINS evaluation was longer in group S than that in group U (20 vs. 10 months, p=0.0221). In multivariate analysis, PSA level, visceral metastasis, and spinal instability were significant prognostic factors. The hazard ratio for patients in group U was 2.60 (95%CI=1.07-5.93, p=0.0345).
Spinal stability evaluated using SINS is a new prognostic factor for survival of patients with spinal metastasis of CRPC.
背景/目的：评估脊柱不稳定肿瘤评分（SINS）对去势抵抗性前列腺癌（CRPC）脊柱转移患者生存情况的预测价值。
采用SINS对CRPC患者进行脊柱不稳定情况的回顾性研究。从SINS评估时间开始计算总生存期。研究对象为2013年12月至2016年7月32个月内在川崎医科大学医院接受全身计算机断层扫描的42152例患者中，经放射科医生诊断为转移性脊柱肿瘤的261例患者中的42例CRPC患者。
中位年龄为78岁（范围=55 - 91岁），SINS评估时前列腺特异性抗原（PSA）水平中位数为42.1（0.1 - 3121.6）ng/ml，11例患者发生内脏转移。从骨转移诊断到CRPC发生再到SINS评估的中位时间分别为17（0 - 158）个月和20（0 - 149）个月。32例患者脊柱稳定（S组），10例（24%）潜在不稳定或不稳定（U组）。中位观察期为17.5（0 - 83）个月，36例患者死亡。SINS评估后S组的中位生存期长于U组（20个月对10个月，p = 0.0221）。多因素分析中，PSA水平、内脏转移和脊柱不稳定是显著的预后因素。U组患者的风险比为2.60（95%CI = 1.07 - 5.93，p = 0.0345）。
使用SINS评估的脊柱稳定性是CRPC脊柱转移患者生存的一个新的预后因素。
