Noli Luigi Emanuele, Alcherigi Chiara, Griffoni Cristiana, Pesce Eleonora, Rosa Simona, Evangelisti Gisberto, Pipola Valerio, Davassi Paolo Francesco, Monetta Annalisa, Barbanti Brodano Giovanni, Terzi Silvia, Ghermandi Riccardo, Tedesco Giuseppe, Girolami Marco, Bandiera Stefano, Gasbarrini Alessandro
ISNB Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
Front Oncol. 2024 Nov 20;14:1485226. doi: 10.3389/fonc.2024.1485226. eCollection 2024.
Retrospective analysis.
The aim of this study is to evaluate the functional outcomes and the health-related quality of life (HRQOL) in patients undergoing en bloc resection of spinal tumor.
En bloc resection in the spine is a surgical procedure designed to completely remove a tumor in one piece, with wide margins preserved, in order to reduce the risk of local recurrences. This demanding procedure has been shown to improve local control and survival rate, besides a relatively high morbidity.
Between 2016 and 2021, 70 patients underwent en bloc resection surgery for a primary spine tumor and 38 came out to be eligible for this analysis. Eligibility criteria include at least one follow-up visit within a two-year period from surgery and Patient Reported Outcomes evaluation collected prospectively at baseline and at least one follow- up in the range 4-24 months. The outcome variables (EQ5D Numeric Scale and Index, SF36 scores and NRS score) were analyzed with multilevel linear mixed-effects regression. Baseline- (age, gender, localization, histotype, number of levels of resection, previous surgery) and time-dependent covariates (adverse events, spinal cord damage) were included.
Beside a slight improvement of all the scores, no significant differences were found between baseline and follow up times for EQ-5D-3L Numeric Scale and Index and for SF-36 Standardized Physical component. SF-36 Standardized Mental component appeared to be significantly better at 12-month FU compared to baseline. Ultimately, age over 50 years old and the occurrence of adverse events emerged to be as the two main factor determining worsening in several HRQOL scores. Pain came out to be significantly reduce at 24-month compared to baseline.
The aim of en bloc resection in the treatment of primary spinal tumors is to improve survival rates and reduce local recurrences. Despite its radicality, our preliminary results suggest that patients experience a slight to moderate improvement postoperatively compared to their preoperative perceived health status.
回顾性分析。
本研究旨在评估接受脊柱肿瘤整块切除术患者的功能结局及与健康相关的生活质量（HRQOL）。
脊柱整块切除术是一种手术操作，旨在完整切除肿瘤，保留广泛切缘，以降低局部复发风险。除了发病率相对较高外，这一高要求的手术已被证明可改善局部控制和生存率。
2016年至2021年期间，70例患者接受了原发性脊柱肿瘤整块切除手术，其中38例符合本分析条件。纳入标准包括术后两年内至少一次随访，以及前瞻性收集的患者报告结局评估，基线时及术后4至24个月内至少一次随访。采用多水平线性混合效应回归分析结局变量（EQ5D数字量表和指数、SF36评分和NRS评分）。纳入基线协变量（年龄、性别、肿瘤位置、组织学类型、切除节段数、既往手术史）和时间依赖性协变量（不良事件、脊髓损伤）。
除所有评分略有改善外，EQ-5D-3L数字量表和指数以及SF-36标准化身体成分在基线和随访时无显著差异。SF-36标准化心理成分在随访12个月时与基线相比明显更好。最终，50岁以上年龄和不良事件的发生是导致几个HRQOL评分恶化的两个主要因素。与基线相比，24个月时疼痛明显减轻。
原发性脊柱肿瘤整块切除术的目的是提高生存率并减少局部复发。尽管该手术具有根治性，但我们的初步结果表明，与术前感知的健康状况相比，患者术后有轻微至中度改善。
