Prognostic parameters and spinal metastases: a research study.
Prognostic parameters and spinal metastases: a research study.
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DOI：
10.1371/journal.pone.0109579
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Veiga JC
中科院分区：
文献类型：
--
作者：
Daniel JW;Veiga JC
确定原发肿瘤未知时脊髓硬膜外肿瘤转移患者的术前生存预后参数。本研究是对1997年2月至2011年1月期间接受脊髓硬膜外肿瘤转移手术的患者进行的回顾性图表审查。入选标准如下：已知的术后生存期、Karnofsky性能评分等于或大于30分和术后肿瘤转移组织学类型。Kaplan-Meier法用于估计术后生存率，Log-Rank检验用于统计推断。共确定了52例患者接受了52例外科手术。脊柱手术时的平均年龄为53.92岁（std.偏差，19.09）。术后中位生存期为70天（95%CI 49.97-90.02），38例（73.07%）患者术后6个月内死亡。肺癌、前列腺癌、骨髓瘤和淋巴瘤是4种最常见的原发性肿瘤类型，32例（61.53%）患者受累。确定的三个预后参数如下：术前行走能力丧失（美国脊柱损伤协会，A和B），86.53%的患者存在（p值= 0.107）;特殊护理依赖性（Karnofsky性能评分，10-40分），90.38%的患者存在（p值= 0.322）;与硬膜囊接触的椎体硬膜外肿瘤转移（Weinstein-Boriani-Biagini，D区），94.23%的患者存在（p值= 0.643）。 当结合三个次要预后参数时，平均术后生存期为45天;当至少存在一个时，生存期为82天（p值= 0.175）。 行走能力，特殊护理依赖性和肿瘤转移与鞘囊之间的接触可以帮助确定该患者人群的最终生存率，以及哪些患者可能从手术与单独姑息治疗中获益。术后2- 3个月的生存期证明手术治疗是合理的。
To identify pre-operative prognostic parameters for survival in patients with spinal epidural neoplastic metastasis when the primary tumour is unknown. This study was a retrospective chart review of patients who underwent surgery for spinal epidural neoplastic metastases between February 1997 and January 2011. The inclusion criteria were as follows: known post-operative survival period, a Karnofsky Performance Score equal to or greater than 30 points and a post-operative neoplastic metastasis histological type. The Kaplan-Meier method was used to estimate post-operative survival, and the Log-Rank test was used for statistical inference. A total of 52 patients who underwent 52 surgical procedures were identified. The mean age at the time of spinal surgery was 53.92 years (std. deviation, 19.09). The median survival after surgery was 70 days (95% CI 49.97–90.02), and post-operative mortality occurred within 6 months in 38 (73.07%) patients. Lung cancer, prostate cancer, myeloma and lymphoma, the 4 most common primary tumour types, affected 32 (61.53%) patients. The three identified prognostic parameters were the following: pre-operative walking incapacity (American Spinal Injury Association, A and B), present in 86.53% of the patients (p-value = 0.107); special care dependency (Karnofsky Performance Score, 10–40 points), present in 90.38% of the patients (p-value = 0.322); and vertebral epidural neoplastic metastases that were in contact with the thecal sac (Weinstein-Boriani-Biagini, sector D), present in 94.23% of the patients (p-value = 0.643). When the three secondary prognostic parameters were combined, the mean post-operative survival was 45 days; when at least one was present, the survival was 82 days (p-value = 0.175). Walking incapacity, special care dependency and contact between the neoplastic metastases and the thecal sac can help determine the ultimate survival of this patient population and, potentially, which patients would benefit from surgery versus palliation alone. A 2- to 3-month post-operative survival period justified surgical treatment.
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