Hill M E, Richards M A, Gregory W M, Smith P, Rubens R D
ICRF Clinical Oncology Unit, Guy's Hospital, London, UK.
Br J Cancer. 1993 Nov;68(5):969-73. doi: 10.1038/bjc.1993.463.
Spinal cord compression (SCC) is a relatively uncommon but frequently disabling complication of metastatic breast cancer. We have conducted this retrospective study of 70 patients with SCC secondary to breast cancer with the aims of determining risk factors for its development and predictors of outcome. Median age at diagnosis of breast cancer was 51 years with median time to SCC 42 months. All patients had radiological evidence of bone metastases at the time of SCC, and only five were not known to have bone metastases prior to SCC. The most frequent symptom of SCC was motor weakness (96%) followed by pain (94%), sensory disturbance (79%) and sphincter disturbance (61%). Ninety-one percent of patients had at least one symptom for more than a week. Radiotherapy (RT) was given as primary treatment in 43 cases, whilst 21 had decompressive surgery and seven of these went onto have postoperative radiotherapy. Six patients were deemed too unwell for either modality. Following treatment, 96% of those who were ambulant before therapy maintained the ability to walk. In those unable to walk, 45% regained ambulation, with RT and surgery being equally effective. Median survival following SCC was 4 months, with no significant difference between those treated by RT or surgery. The most important predictor of survival was ability to walk after treatment, followed by time from diagnosis of breast cancer to SCC. We conclude that the majority of patients have warning symptoms of SCC and that nearly all will have evidence of spinal bone metastases before compression occurs. The results suggest that earlier diagnosis and intervention could improve outcome. There was no evidence of benefit from surgery over radiotherapy as primary treatment, survival in both treatment groups being poor.
脊髓压迫症（SCC）是转移性乳腺癌相对少见但常导致残疾的并发症。我们对70例继发于乳腺癌的脊髓压迫症患者进行了这项回顾性研究，目的是确定其发生的危险因素和预后的预测因素。乳腺癌诊断时的中位年龄为51岁，发生脊髓压迫症的中位时间为42个月。所有患者在发生脊髓压迫症时均有骨转移的影像学证据，只有5例在发生脊髓压迫症之前未知有骨转移。脊髓压迫症最常见的症状是运动无力（96%），其次是疼痛（94%）、感觉障碍（79%）和括约肌功能障碍（61%）。91%的患者至少有一种症状持续超过一周。43例患者接受放射治疗（RT）作为主要治疗，21例接受减压手术，其中7例术后接受放射治疗。6例患者因病情过重无法接受任何一种治疗方式。治疗后，治疗前能行走的患者中有96%维持了行走能力。在不能行走的患者中，45%恢复了行走能力，放射治疗和手术的效果相当。脊髓压迫症后的中位生存期为4个月，放射治疗或手术治疗的患者之间无显著差异。生存的最重要预测因素是治疗后行走的能力，其次是从乳腺癌诊断到发生脊髓压迫症的时间。我们得出结论，大多数患者有脊髓压迫症的警示症状，几乎所有患者在压迫发生前都有脊柱骨转移的证据。结果表明，早期诊断和干预可能改善预后。没有证据表明手术作为主要治疗比放射治疗更有益，两个治疗组的生存率都很低。
