Pojskić Mirza, Saß Benjamin, Bopp Miriam H A, Wilke Sebastian, Nimsky Christopher
Department of Neurosurgery, University of Marburg, 35037 Marburg, Germany.
Center for Mind, Brain and Behavior (CMBB), 35043 Marburg, Germany.
Cancers (Basel). 2024 Dec 20;16(24):4248. doi: 10.3390/cancers16244248.
The aim of this study was to assess the surgical outcomes and survival of patients surgically treated for metastatic epidural spinal cord compression (MESCC), with a specific focus on identifying factors that influence overall survival and readmission-free survival.
All patients who underwent surgery for spine metastases at our department in the period 2018-2022 were included in the study.
A total of 175 patients (n = 71 females, median age 67.15 years) were included. The most common primary tumors were lung carcinoma (n = 31), prostate carcinoma (n = 31), breast carcinoma (n = 28), multiple myeloma (n = 25), and renal cell carcinoma (n = 11). ECOG performance status was 0 (n = 7), 1 (n = 97), 2 (n = 27), 3 (n = 17), and 4 (n = 27). Pathological fractures were present in n = 108 patients. Decompression only was performed in n = 42, additional instrumentation in n = 133, and vertebral body replacement in n = 23. The most common complications were wound healing deficits and hardware failure. Preoperative motor deficits were present in n = 89 patients. Postoperatively, n = 122 improved, n = 43 was unchanged, and n = 10 deteriorated. Mean overall survival (OS) was 239.2 days, with a 30-day mortality rate of 18.3%. Favorable prognostic factors included Tomita score < 7, Frankel score A-C, ECOG 0-1, and Modified Tokuhashi score > 10 ( < 0.01). Factors affecting OS and readmission-free survival (RFS) included prognostic scores, adjuvant therapy, ASA classification, surgical complications, metastasis number, and postoperative improvement. Better prognostic scores, adjuvant therapy, and clinical improvement were associated with longer OS and RFS, while complications or deterioration resulted in worse outcomes.
Patients undergoing decompression and/or stabilization for metastatic spinal tumors showed improved outcomes, with favorable prognosis linked to Tomita score < 7, Frankel score A-C, ECOG 0-1, and Modified Tokuhashi score > 10.
本研究旨在评估接受手术治疗的转移性硬膜外脊髓压迫症（MESCC）患者的手术效果和生存率，特别关注确定影响总生存率和无再入院生存率的因素。
纳入2018年至2022年期间在我科接受脊柱转移瘤手术的所有患者。
共纳入175例患者（n = 71例女性，中位年龄67.15岁）。最常见的原发肿瘤为肺癌（n = 31）、前列腺癌（n = 31）、乳腺癌（n = 28）、多发性骨髓瘤（n = 25）和肾细胞癌（n = 11）。东部肿瘤协作组（ECOG）体能状态为0（n = 7）、1（n = 97）、2（n = 27）、3（n = 17）和4（n = 27）。108例患者存在病理性骨折。仅行减压手术的有42例，行额外内固定的有133例，行椎体置换的有23例。最常见的并发症是伤口愈合不良和内固定失败。89例患者术前存在运动功能障碍。术后，122例改善，43例无变化，10例恶化。平均总生存期（OS）为239.2天，30天死亡率为18.3%。有利的预后因素包括Tomita评分< 7、Frankel评分A - C、ECOG 0 - 1以及改良Tokuhashi评分> 10（P < 0.）。影响OS和无再入院生存率（RFS）的因素包括预后评分、辅助治疗、美国麻醉医师协会（ASA）分级、手术并发症、转移灶数量和术后改善情况。较好的预后评分、辅助治疗和临床改善与更长的OS和RFS相关，而并发症或病情恶化则导致更差的结果。
接受转移性脊柱肿瘤减压和/或稳定手术的患者预后有所改善，有利的预后与Tomita评分< 7、Frankel评分A - C、ECOG 0 - 1以及改良Tokuhashi评分> 10相关。
