脊柱不稳肿瘤评分与硬膜外脊髓压迫相关——256 例脊柱转移瘤手术治疗患者的回顾性队列研究。
The Spinal Instability Neoplastic Score correlates with epidural spinal cord compression -a retrospective cohort of 256 surgically treated patients with spinal metastases.
机构信息
Department of Diagnostics and Intervention, Umeå University, Umeå, Sweden.
出版信息
BMC Musculoskelet Disord. 2024 Aug 15;25(1):644. doi: 10.1186/s12891-024-07756-9.
BACKGROUND
Bone metastases can compromise the integrity of the spinal canal and cause epidural spinal cord compression (ESCC). The Spinal Instability Neoplastic Score (SINS) was developed in order to evaluate spinal instability due to a neoplastic process. The SINS has reached wide acceptance among clinicans but its prognostic value is still controversial. The aim was to investigate the correlation between the SINS and ESCC and the association between SINS and ambulation before and survival after surgery.
METHODS
Correlations were assessed between SINS and grades of ESCC in patients who underwent spine surgery for spinal metastases. CT and MRI were used to calculate SINS and the grades of ESCC respectively. Correlations were analyzed with the Spearman's correlation test. Postoperative survival was estimated with Kaplan-Meier analysis and survival curves were compared with the log-rank test. The Cox proportional hazard model was used to assess the effect of prognostic variables including age, ambulation before surgery, SINS, and the Karnofsky Performance Status (KPS) as covariates.
RESULTS
The study included 256 patients (196 men and 60 women) with a median age of 70 (24-88) years. The mean SINS was 10. One hundred fifty-two patients (59%) had lost ambulation before surgery. One hundred and one patients had grades 0-2 and 155 patients had grade 3 according to the ESCC-scale. SINS correlated with the grades of ESCC (p = 0.001). The SINS score was not associated with ambulation before surgery (p = 0.63). The median postoperative survival was 10 months, and there was no difference in postoperative survival between the SINS categories (p = 0.25). The ability to walk before surgery and a high KPS were associated with longer postoperative survival.
CONCLUSION
SINS correlated with grades of ESCC, which implies that higher SINS may be considered as an indicator of risk for developing ESCC. The SINS was not associated with ambulation before or survival after surgery.
背景
骨转移可破坏椎管的完整性并导致硬膜外脊髓压迫症（ESCC）。Spinal Instability Neoplastic Score（SINS）是为了评估因肿瘤过程引起的脊柱不稳定而开发的。SINS 在临床医生中得到了广泛认可，但它的预后价值仍存在争议。目的是研究 SINS 与 ESCC 的相关性以及 SINS 与手术前后的活动能力和生存的关系。
方法
评估了因脊柱转移而行脊柱手术的患者的 SINS 与 ESCC 分级之间的相关性。使用 CT 和 MRI 分别计算 SINS 和 ESCC 分级。使用 Spearman 相关检验分析相关性。使用 Kaplan-Meier 分析估计术后生存，并使用对数秩检验比较生存曲线。使用 Cox 比例风险模型评估包括年龄、术前活动能力、SINS 和 Karnofsky 表现状态（KPS）在内的预后变量的作用作为协变量。
结果
该研究包括 256 名患者（196 名男性和 60 名女性），中位年龄为 70 岁（24-88 岁）。152 名患者（59%）在术前失去了活动能力。根据 ESCC 量表，101 名患者为 0-2 级，155 名患者为 3 级。SINS 与 ESCC 分级相关（p=0.001）。SINS 评分与术前活动能力无关（p=0.63）。术后中位生存时间为 10 个月，SINS 类别之间的术后生存无差异（p=0.25）。术前行走能力和高 KPS 与术后生存时间延长相关。
结论
SINS 与 ESCC 分级相关，这意味着较高的 SINS 可能被视为发生 ESCC 的风险指标。SINS 与手术前后的活动能力和生存无关。
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