Lee JunYeop, Chang Bong-Soon, Kim Hyoungmin, Kim Sung Taeck, Jang Seonpyo, Chang Sam Yeol
Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehangro, Jongrogu, Seoul 03080, Republic of Korea.
Cancers (Basel). 2025 May 1;17(9):1539. doi: 10.3390/cancers17091539.
The current study aimed to evaluate the effect of denosumab on patients with impending instability due to spinal metastasis, including whether it can improve spinal instability neoplastic score (SINS) and reduce the need for surgical treatment.
This study retrospectively reviewed patients initially treated non-operatively for metastatic spinal lesions with intermediate SINS (7-12 points) between January 2017 and December 2023 in a single tertiary cancer hospital. Patients were divided into two groups based on the use of denosumab for the intermediate SINS lesion: D-group and N-group. Propensity score matching (PSM) was conducted with a caliper width of 0.025 for the covariates (age, sex, and primary cancer). The study outcomes were (1) the rate of conversion to surgery, (2) the change in SINS, and (3) the change in HU (Hounsfield unit) during the follow-up period.
A total of 286 patients (male 151, female 135) with a mean age of 68.0 ± 12.6 years and a mean follow-up period of 37.1 ± 26.5 months were included. Forty-one (14.3%) patients received denosumab (D-group), whereas 245 (85.7%) did not receive denosumab (N-group). Before PSM, 9.8% (4/41) in the D-group and 18.8% (46/245) in the N-group underwent surgical treatment. The rate of conversion to surgery was similar after PSM: the D-group, 8.3% (3/36) vs. the N-group, 16.6% (6/36). Survival analysis using Kaplan-Meier curves also showed that the D-group had a significantly lower probability of conversion to surgery before and after PSM ( = 0.015 and = 0.023, respectively). In addition, the D-group showed significant improvements in the SINS (total score, pain, and bone lesion scores) and HU after denosumab treatment.
In this study, denosumab lowered the rate of conversion to surgery in patients with impending instability (intermediate SINS) due to spinal metastasis. Patients who received denosumab treatment showed significant improvements in the SINS and HU for their metastatic spinal lesions.
本研究旨在评估地诺单抗对因脊柱转移而即将出现不稳定的患者的疗效，包括其是否能改善脊柱不稳定肿瘤评分（SINS）并减少手术治疗的需求。
本研究回顾性分析了2017年1月至2023年12月期间在一家三级癌症专科医院接受非手术初始治疗的中度SINS（7 - 12分）转移性脊柱病变患者。根据是否使用地诺单抗治疗中度SINS病变将患者分为两组：D组和N组。对协变量（年龄、性别和原发癌）进行倾向评分匹配（PSM），卡尺宽度为0.025。研究结果包括：（1）手术转换率；（2）SINS的变化；（3）随访期间Hounsfield单位（HU）的变化。
共纳入286例患者（男性151例，女性135例），平均年龄68.0±12.6岁，平均随访期37.1±26.5个月。41例（14.3%）患者接受地诺单抗治疗（D组），245例（85.7%）未接受地诺单抗治疗（N组）。PSM前，D组9.8%（4/41）和N组18.8%（46/245）接受了手术治疗。PSM后手术转换率相似：D组为8.3%（3/36），N组为16.6%（6/36）。使用Kaplan - Meier曲线进行的生存分析还显示，PSM前后D组手术转换的概率显著更低（分别为 = 0.015和 = 0.023）。此外，D组在接受地诺单抗治疗后SINS（总分、疼痛和骨病变评分）和HU有显著改善。
在本研究中，地诺单抗降低了因脊柱转移而即将出现不稳定（中度SINS）患者的手术转换率。接受地诺单抗治疗的患者其转移性脊柱病变的SINS和HU有显著改善。
