手术治疗脊柱转移瘤患者的预后

martinbigbird 2024-01-27 发布于广东

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Edited by Spine Truth Editorial Team

脊柱甘露语林®中国助学网西安站

学术·疾病与健康科普·助学·公益行

之3056天，第1708篇

编辑：张军主任医师

审校总编辑：王海强教授

随着肿瘤治疗方案的进步，癌症患者的生命也在延长，因而脊柱转移瘤变得越来越常见[1-3]。脊柱转移瘤是晚期癌症患者发病的一个重要原因，治疗通常需要手术干预。然而，脊柱转移瘤的最佳治疗策略还没有很好的定义，很大程度上取决于每个人的临床情况。

总的来说，脊柱转移瘤患者可以通过放射治疗(RT)、全身治疗、介入技术(如后凸成形术)或手术进行治疗，后者包括整体转移瘤切除术、减瘤术或稳定手术[4-8]。手术通常适用于脊柱不稳定、神经受压和先前干预无法解决疼痛的患者[9-12]。

常用于脊髓转移的评分系统包括Tomita评分、改良Bauer评分和Tokuhashi评分。Tomita评分系统参考了恶性肿瘤的生长速度、内脏转移的存在以及单发与多发骨转移的存在[13]。Tokuhashi评分系统包括了患者的表现状态（performance status）、椎体转移数量、脊柱外骨转移的数量、内脏转移数量、原发肿瘤类型和神经系统状态[14]。改良的Bauer评分包括内脏转移的存在、肿瘤类型和椎体转移的数量[15]。

然而，在Lee等人的荟萃分析中，Tomita和Tokuhashi评分在预测6个月生存率方面的准确性较低[16]，而且这些评分在现代领域的实用性尚不清楚，特别是因为它们是在20世纪80年代至21世纪初的患者中开发的，而在当时尚未出现目前较为先进的肿瘤治疗方法。

最近开发的一种工具是新英格兰脊柱转移评分(NESMS)[17]，它使用改良的Bauer评分、血清白蛋白和活动状态(受损与未受损)，并被证明可预测1年和30天死亡率[18]。虽然该评分来自2007年至2013年接受治疗的患者，但在2017年至2018年接受治疗的180例患者的研究中，该评分已被前瞻性验证为6个月和1年死亡率的预测指标[19]。在一项对202例患者的前瞻性研究中[20]，NESMS比Tokuhashi、Tomita和脊柱不稳定肿瘤评分在更高程度上能够区分生存率，但在Garza-Ramos等人的另一项回顾性研究中[21]，NESMS未达到预先定义的临床实用阈值，因此最佳预测工具仍有待确定。

近期有学者[22]发表了一项单中心回顾性分析，以术后180天时的死亡率作为主要结局，以评估手术治疗脊柱转移瘤患者预后不良的危险因素。研究结果显示：年龄>65岁、脊柱外转移和ECOG体力状况评分>1级者，是手术治疗脊柱转移瘤患者180天死亡率相关的风险因素。具有这些因素且体重指数BMI≤30mg/kg2的患者，总体生存率较差。因此，术前对具有这些危险因素的脊柱转移瘤患者，需充分进行手术获益和风险的多学科讨论，以评估是否有必要对其开展脊柱转移瘤手术。

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