Kang Dong-Ho, Jung Kyunghun, Park Jin-Sung, Kang Minwook, Lee Chong-Suh, Park Se-Jun
Department of Orthopedic Surgery, Samsung Medical Center, Seoul 06351, Republic of Korea.
Department of Orthopedic Surgery, Haeundae Bumin Hospital, Busan 48094, Republic of Korea.
J Clin Med. 2024 Dec 23;13(24):7860. doi: 10.3390/jcm13247860.
Although the Spinal Instability Neoplastic Score (SINS) is widely utilized to evaluate spinal instability, its prognostic value for survival in patients with cervical spinal metastases remains unclear. This study investigated the association between the SINS and survival outcomes in patients with metastatic cervical spine cancer. This retrospective cohort study included 106 patients who underwent surgery for metastatic cervical spine cancer at a single institution between 1995 and 2023. Patients were divided into two groups: high SINS (≥13) and low-to-moderate SINS (0-12). Overall survival (OS) was the primary outcome and was analyzed using Kaplan-Meier estimates and Cox regression. Secondary outcomes included changes in Eastern Cooperative Oncology Group Performance Status (ECOG-PS), operation time, estimated blood loss, and postoperative complications. The median OS was significantly shorter in the high SINS group compared to the low-to-moderate SINS group (5.3 months versus 8.6 months; = 0.023). A high SINS was independently associated with increased mortality risk (hazard ratio [HR], 1.959; 95% CI, 1.221-3.143; = 0.005). Lung cancer (HR, 4.004; 95% CI, 1.878-8.535; < 0.001) and rectal cancer (HR, 3.293; 95% CI, 1.126-9.632; = 0.029) were predictive of worse survival, whereas postoperative chemotherapy (HR, 0.591; 95% CI, 0.381-0.917; = 0.019) and radiotherapy (HR, 0.531; 95% CI, 0.340-0.827; = 0.005) were associated with improved survival. Changes in the ECOG-PS and postoperative complication rates were not significantly different between the groups. A high SINS was associated with significantly shorter survival in patients with metastatic cervical spine cancer, reflecting both mechanical instability and tumor aggressiveness.
尽管脊柱不稳定肿瘤评分（SINS）被广泛用于评估脊柱稳定性，但其对颈椎转移瘤患者生存的预后价值仍不明确。本研究调查了SINS与颈椎转移癌患者生存结局之间的关联。这项回顾性队列研究纳入了1995年至2023年间在单一机构接受颈椎转移癌手术的106例患者。患者分为两组：高SINS组（≥13）和低至中度SINS组（0 - 12）。总生存期（OS）是主要结局，采用Kaplan - Meier估计和Cox回归进行分析。次要结局包括东部肿瘤协作组体能状态（ECOG - PS）的变化、手术时间、估计失血量和术后并发症。与低至中度SINS组相比，高SINS组的中位OS显著缩短（5.3个月对8.6个月；P = 0.023）。高SINS与死亡风险增加独立相关（风险比[HR]，1.959；95%置信区间，1.221 - 3.143；P = 0.005）。肺癌（HR，4.004；95%置信区间，1.878 - 8.535；P < 0.001）和直肠癌（HR，3.293；95%置信区间，1.126 - 9.632；P = 0.029）预示生存较差，而术后化疗（HR，0.591；95%置信区间，0.381 - 0.917；P = 0.019）和放疗（HR，0.531；95%置信区间，0.340 - 0.827；P = 0.005）与生存改善相关。两组之间ECOG - PS的变化和术后并发症发生率无显著差异。高SINS与颈椎转移癌患者的生存期显著缩短相关，反映了机械性不稳定和肿瘤侵袭性。
