Predictive value of seven preoperative prognostic scoring systems for spinal metastases
Predictive value of seven preoperative prognostic scoring systems for spinal metastases
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DOI：
10.1007/s00586-008-0763-1
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发表时间：
2008-11-01
影响因子：
2.8
通讯作者：
Windhager, Reinhard
中科院分区：
文献类型：
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作者：
Leithner, Andreas;Radl, Roman;Windhager, Reinhard
预测预后是脊柱转移瘤患者选择适当治疗方式的关键因素。因此，设计了各种评估系统，以便为决定治疗过程提供依据。这样的系统已经由Tokuhashi、Sioutos、Tomita、货车der林登和鲍尔提出。在评估的参数种类上，得分差别很大。本研究的目的是评估每个评分的预后价值。评估了69例患者（37例男性，32例女性）的8个参数：位置、一般状况、脊柱外骨转移瘤数量、脊柱转移瘤数量、内脏转移瘤、原发性肿瘤、脊髓麻痹严重程度和病理性骨折。根据Tokuhashi（原始和修订版）、Sioutos、Tomita、货车der林登和Bauer评分以及改良的Bauer评分进行评估，不对病理性骨折进行评分。截至2006年9月，19名患者仍然存活，至少随访12个月。所有其他患者均在术后平均17个月后死亡。肺癌的平均总生存期仅为3个月，其次是前列腺癌（7个月）、肾癌（23个月）、乳腺癌（35个月）和多发性骨髓瘤（51个月）。在单变量生存分析中，原发肿瘤和内脏转移是显著参数，而Karnofsky评分仅在包括骨髓瘤患者的组中具有显著性。在所有7个参数的多变量分析中，原发性肿瘤和内脏转移是仅有的显著参数。在所有7种评分系统中，原始Bauer评分和不含病理性骨折评分的Bauer评分与生存率的相关性最好（P < 0.001）。本研究的数据强调，原始的Bauer评分和修改后的Bauer评分没有评分的病理性骨折似乎是可行的和高度预测术前评分系统的脊柱转移瘤患者。然而，决定是否手术不应该仅仅基于预后评分，而应该考虑疼痛或神经损害等症状。
Predicting prognosis is the key factor in selecting the proper treatment modality for patients with spinal metastases. Therefore, various assessment systems have been designed in order to provide a basis for deciding the course of treatment. Such systems have been proposed by Tokuhashi, Sioutos, Tomita, Van der Linden, and Bauer. The scores differ greatly in the kind of parameters assessed. The aim of this study was to evaluate the prognostic value of each score. Eight parameters were assessed for 69 patients (37 male, 32 female): location, general condition, number of extraspinal bone metastases, number of spinal metastases, visceral metastases, primary tumour, severity of spinal cord palsy, and pathological fracture. Scores according to Tokuhashi (original and revised), Sioutos, Tomita, Van der Linden, and Bauer were assessed as well as a modified Bauer score without scoring for pathologic fracture. Nineteen patients were still alive as of September 2006 with a minimum follow-up of 12 months. All other patients died after a mean period of 17 months after operation. The mean overall survival period was only 3 months for lung cancer, followed by prostate (7 months), kidney (23 months), breast (35 months), and multiple myeloma (51 months). At univariate survival analysis, primary tumour and visceral metastases were significant parameters, while Karnofsky score was only significant in the group including myeloma patients. In multivariate analysis of all seven parameters assessed, primary tumour and visceral metastases were the only significant parameters. Of all seven scoring systems, the original Bauer score and a Bauer score without scoring for pathologic fracture had the best association with survival (P < 0.001). The data of the present study emphasize that the original Bauer score and a modified Bauer score without scoring for pathologic fracture seem to be practicable and highly predictive preoperative scoring systems for patients with spinal metastases. However, decision for or against surgery should never be based alone on a prognostic score but should take symptoms like pain or neurological compromise into account.