Prediction of survival in patients with metastases in the spinal column - Results based on a randomized trial of radiotherapy
Prediction of survival in patients with metastases in the spinal column - Results based on a randomized trial of radiotherapy
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DOI：
10.1002/cncr.20756
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发表时间：
2005-01-15
期刊：
影响因子：
6.2
通讯作者：
Leer, JWH
中科院分区：
文献类型：
--
作者：
van der Linden, YM;Dijkstra, SPDS;Leer, JWH
充分的生存预测对于决定有症状的脊柱转移瘤患者的治疗是很重要的。作者回顾了342例无神经功能损害的疼痛性脊柱转移瘤患者，这些患者在一项大型前瞻性随机放疗试验中接受保守治疗。放疗反应和预后因素的生存率进行了研究。方法采用荷兰骨转移研究的数据库。使用考克斯回归模型研究治疗反应和总生存期（OS）的预后因素。开发了一个评分系统来预测OS。在73%的患者中观察到了抗肿瘤反应。3%的患者在随机化后平均3.5个月报告脊髓压迫。中位OS为7个月，生存率的重要预测因素为Karnofsky评分、原发肿瘤（多变量分析;均P < 0.001）和无内脏转移（多变量分析;P= 0.02）。基于这些预测因素开发了评分系统，34%的患者在A组（中位OS = 3.0个月），48%的患者在B组（中位OS = 9.0个月），18%的患者在C组（中位OS = 18.7个月）。C组是由乳腺癌患者，一个良好的性能，没有内脏metastases.CONCLUSIONSMOST脊柱转移瘤患者的预期寿命有限，应谨慎对待有关的外科手术。放射治疗是一种安全、有效、无创的疼痛治疗方法。新的评分系统将使医生能够选择那些可能存活足够长的患者，以从更激进的治疗中获益。癌症2005年。© 2004美国癌症协会。
BACKGROUNDAdequate prediction of survival is important in deciding on treatment for patients with symptomatic spinal metastases. The authors reviewed 342 patients with painful spinal metastases without neurologic impairment who were treated conservatively within a large, prospectively randomized radiotherapy trial. Response to radiotherapy and prognostic factors for survival were studied.METHODSThe data base of the Dutch Bone Metastasis Study was used. Response to treatment and prognostic factors for overall survival (OS) were studied using a Cox regression model. A scoring system was developed to predict OS.RESULTSResponses were noted in 73% of patients. In 3% of patients, spinal cord compression was reported a mean of 3.5 months after randomization. The median OS was 7 months, and significant predictors for survival were Karnofsky performance score, primary tumor (multivariate analysis; bothP< 0.001), and the absence of visceral metastases (multivariate analysis;P= 0.02). A scoring system based on these predictors was developed, and 34% of patients were in Group A (median OS = 3.0 months), 48% of patients were in Group B (median OS = 9.0 months), and 18% of patients were in Group C (median OS = 18.7 months). Group C was comprised of patients with breast carcinoma, a good performance, and no visceral metastases.CONCLUSIONSMost patients with spinal metastases have a limited life expectancy and should be treated with caution regarding surgical procedures. Radiotherapy is a safe and effective, noninvasive treatment modality for pain. The new scoring system will enable physicians to select patients who may survive long enough to benefit from more radical treatment. Cancer 2005. © 2004 American Cancer Society.