Dibs Khaled, Mageswaran Prasath, Raval Raju, Thomas Evan, Gogineni Emile, Pan Jeff, Klamer Brett, Ayan Ahmet, Bourekas Eric, Boulter Daniel, Fetko Nicholas, Cochran Eric, Chakravarthy Vikram, McGregor John, Tili Esmerina, Palmer Joshua, Peters Natalie, Lonser Russell, Elguindy Ahmed, Yap Eugene, Soghrati Soheil, Marras William, Grecula John, Chakravarti Arnab, Elder James, Blakaj Dukagjin
H&N/IORT and CNS/Pediatrics Lead Spine Division Radiation Oncology, The James Cancer Center, The Ohio State University Wexner Medical Center, 460 W. 10th Ave- Room D252N, Columbus, OH, 43210, USA.
The Spine Research Institute, College of Engineering, The Ohio State University, Columbus, OH, USA.
Radiat Oncol. 2025 May 14;20(1):74. doi: 10.1186/s13014-025-02658-z.
Vertebral compression fracture (VCF) is a potential serious complication of spinal stereotactic body radiotherapy (SBRT). Previously we noted a correlation between advanced Spinal Instability Neoplastic Score (SINS), tumor-related endplate (EP) disruption, and certain primary pathologies with increased VCF risk. Here, we report on an expanded patient cohort to further examine EP disruption's role in VCF.
This retrospective cohort study was conducted at a single institution, gathering demographic and treatment data from patients who underwent spinal SBRT between 2013 and 2020. EP disruption was identified on pre-SBRT CT scans. Chronic steroid use was defined as steroids administered for 4 weeks or more. The 1-year cumulative incidence of VCF was evaluated by follow-up MRI and CT scans at 3-month intervals post-treatment. Based on multivariate analysis, a nomogram was created using four independent predictors: EP disruption, steroid use, SINS ≥ 7, and adverse histology.
A total of 173 patients were included. The median follow-up was 19 months. Approximately 69 patients (40%) had EP disruption. Thirty patients (17%) experienced a VCF at a median of 4.8 months from SBRT. Patients with adverse histology (HR 2.98, 95% CI [1.42-6.30], p 0.004), steroid use (HR 3.60, 95% CI [1.36-9.51], p 0.01), EP disruption (HR 4.16, 95% CI [1.57-11.05], p 0.004) and a SINS of ≥ 7 (HR 3.63, 95% CI [1.39-9.46], p 0.001) were associated with increased risk of VCF. Based on these findings, a nomogram was created with these four variables stratifying groups at low, intermediate, and high risk of VCF correlating with rates of 2%, 21% and 58% risk (P <.001).
In this expanded pooled analysis, consistent with previously published findings, EP disruption, adverse pathology, and higher SINS scores were associated with an increased risk of VCF. Additionally, we found that chronic steroid use for four weeks or greater also correlated with a higher risk of VCF.
椎体压缩性骨折（VCF）是脊柱立体定向体部放疗（SBRT）的一种潜在严重并发症。此前我们注意到，较高的脊柱不稳定肿瘤评分（SINS）、肿瘤相关终板（EP）破坏以及某些原发性病理情况与VCF风险增加之间存在相关性。在此，我们报告一个扩大的患者队列，以进一步研究EP破坏在VCF中的作用。
这项回顾性队列研究在单一机构进行，收集了2013年至2020年间接受脊柱SBRT治疗患者的人口统计学和治疗数据。在SBRT前的CT扫描中识别出EP破坏。长期使用类固醇被定义为使用类固醇4周或更长时间。通过治疗后每隔3个月进行的随访MRI和CT扫描评估VCF的1年累积发病率。基于多变量分析，使用四个独立预测因素创建了一个列线图：EP破坏、类固醇使用、SINS≥7以及不良组织学。
共纳入173例患者。中位随访时间为19个月。约69例患者（40%）存在EP破坏。30例患者（17%）在SBRT后中位4.8个月时发生了VCF。不良组织学患者（风险比[HR]2.98，95%置信区间[CI][1.42 - 6.30]，p = 0.004）、使用类固醇患者（HR 3.60，95% CI[1.36 - 9.51]，p = 0.01）、EP破坏患者（HR 4.16，95% CI[1.57 - 11.05]，p = 0.004）以及SINS≥7患者（HR 3.63，95% CI[1.39 - 9.46]，p = 0.001）与VCF风险增加相关。基于这些发现，使用这四个变量创建了一个列线图，将VCF风险分为低、中、高风险组，风险率分别为2%、21%和58%（P < 0.001）。
在这项扩大的汇总分析中，与先前发表的结果一致，EP破坏、不良病理和较高的SINS评分与VCF风险增加相关。此外，我们发现长期使用类固醇4周或更长时间也与较高的VCF风险相关。
