Pierik Robertus J B, Amelink Jantijn J G J, Groot Olivier Q, Som Avik, van Munster Bram T, de Reus Daniël C, Chua Theresa L, Zijlstra Hester, Verlaan Jorrit-Jan, Shin John H, Rabinov James D, Tobert Daniel G
Department of Orthopedic Surgery, Massachusetts General Hospital-Harvard Medical School, Boston, MA.
Department of Orthopedic Surgery, University Medical Center Utrecht, The Netherlands.
Spine (Phila Pa 1976). 2025 Apr 1;50(7):437-446. doi: 10.1097/BRS.0000000000005182. Epub 2024 Oct 14.
Retrospective propensity-score matched, case-control study at 2 academic tertiary care centers.
To assess the effect of preoperative embolization (PE) on (1) intraoperative blood loss, defined as conventional estimates of blood loss (EBL) and hemoglobin mass loss; and (2) secondary outcomes in patients with spinal metastases from hypervascular histologies.
PE intends to reduce blood loss during surgery for spinal metastases of hypervascular tumors such as renal cell carcinoma. However, studies investigating the effect of PE in hypervascular tumors often consist of small cohorts, do not correct for confounding factors, and have conflicting results.
After propensity score matching, 46 PE patients were matched to 46 non-PE patients without baseline differences. The constraints of propensity score matching did not allow analysis of patients with tumor volumes >9 cm 3 . Multiple linear regression models were fitted for EBL and hemoglobin mass loss. Poisson regression models were fitted for both intraoperative and postoperative transfusions.
There was no difference in EBL [948 mL (IQR: 500-1750) vs. 1100 mL (IQR: 388-1925), P =0.68] and hemoglobin mass loss [201 g (IQR: 119-307) vs. 232 g (IQR: 173-373), P =0.18] between PE and non-PE patients. Other than higher 1-year survival rates (65% vs. 43%, P =0.05) in PE patients, there were no differences in secondary outcomes. In multiple regression analyses, PE was not associated with decreased intraoperative blood loss, hemoglobin mass loss, or perioperative blood transfusions.
Our study demonstrated that, for tumors <9 cm 3 , PE did not reduce EBL, hemoglobin mass loss, or perioperative blood transfusions in patients undergoing spine surgery for metastases from hypervascular histologies. These findings suggest that urgent spine surgeries indicated for hypervascular histologies should not be delayed based on the availability of PE and accurate detection of preoperative hypervascularity, beyond histology, will likely be an important determination of future PE utilization for spinal metastases.
Level III-treatment benefits.
在两家学术性三级医疗中心进行的回顾性倾向评分匹配病例对照研究。
评估术前栓塞（PE）对（1）术中失血的影响，术中失血定义为传统的失血估计值（EBL）和血红蛋白质量损失；以及（2）高血供组织学类型的脊柱转移患者的次要结局。
PE旨在减少肾细胞癌等高血供肿瘤脊柱转移手术期间的失血。然而，研究PE在高血供肿瘤中作用的研究通常样本量较小，未对混杂因素进行校正，且结果相互矛盾。
倾向评分匹配后，46例接受PE的患者与46例未接受PE的患者进行匹配，两组患者基线无差异。倾向评分匹配的限制不允许对肿瘤体积>9 cm³ 的患者进行分析。对EBL和血红蛋白质量损失拟合多元线性回归模型。对术中及术后输血拟合泊松回归模型。
PE组和非PE组患者在EBL方面无差异[948 mL（四分位数间距：500 - 1750） vs. 1100 mL（四分位数间距：388 - 1925），P = 0.68]以及血红蛋白质量损失方面无差异[201 g（四分位数间距：119 - 307） vs. 232 g（四分位数间距：173 - 373），P = 0.18]。除了PE组患者1年生存率较高（65% vs. 43%，P = 0.05）外，但在次要结局方面无差异。在多元回归分析中，PE与术中失血减少、血红蛋白质量损失减少或围手术期输血无关。
我们的研究表明，对于体积<9 cm³ 的肿瘤，PE并未减少高血供组织学类型脊柱转移患者脊柱手术中的EBL、血红蛋白质量损失或围手术期输血。这些发现表明，因高血供组织学类型而进行的紧急脊柱手术不应基于PE的可用性而推迟，除组织学外，术前高血供的准确检测可能是未来脊柱转移患者PE应用的重要决定因素。
III级——治疗获益。
