Abstract：
Clear cell renal cell carcinoma (ccRCC) usually spreads in the spinal region causing instability or spinal cord compression leading to neurological deficits. Therefore, surgical treatment is required for improving the outcome of patients. The aim of this study is to identify which prognostic factors could affect overall survival in patients affected by ccRCC. Methods: Retrospective cohort study of patients with ccRCC spinal metastases, surgically treated from November 2009 to April 2019. Demographic and clinical data were collected. The Kaplan−Meier method was used to estimate overall survival, and the log-rank test was used to evaluate differences in survival among potentially prognostic factors. Results: A total of 69 patients were surgically treated and followed up for a median period of 65 months. The average age at the time of surgery was 62.6 years old. The median overall survival (OS) was 34.7 months (95% CI 20.8−51.9) and 5-year OS was 31.2% (95% CI 19.2−44.1). A high Tokuhashi score (p = 0.0217), the presence of visceral metastases (p < 0.001), other bone metastases (p = 0.02012) and the kind of surgical treatment (p = 0.0395) are the main prognostic factors that influence the OS. Moreover, 3-year progression-free survival (PFS) was analyzed: the median PFS was 53.1 months and the % 3-year PFS was 62.9% (45.2−76.3). In the multivariate analysis, only pre-operative radiation therapy had a significant impact on 3-year PFS (95% CI 0.929−12.994, p = 0.0643). Conclusion: The results of this study suggest that the absence of visceral metastases and an aggressive surgery as en-bloc, when feasible, could prolong the survival rate and improve quality of life for patients.
摘要：
透明细胞肾细胞癌（ccRCC）通常在脊柱区域扩散，引起不稳定或脊髓压迫，导致神经功能缺损。因此,需要手术治疗以改善患者的预后。这项研究的目的是确定哪些预后因素可能影响ccRCC患者的总体生存率。方法：ccRCC脊柱转移患者的回顾性队列研究，2009年11月至2019年4月接受手术治疗。收集人口统计学和临床数据。Kaplan-Meier方法用于估计总生存期，并且使用对数秩检验评估潜在预后因素之间的生存率差异.结果：69例患者均行手术治疗，中位随访时间为65个月。手术时的平均年龄为62.6岁。中位总生存期（OS）为34.7个月（95％CI20.8-51.9），5年OS为31.2％（95％CI19.2-44.1）。德桥得分高（p=0.0217），内脏转移的存在（p＆lt;0.001），其他骨转移（p=0.02012）和手术治疗（p=0.0395）是影响OS的主要预后因素。此外，分析了3年无进展生存期（PFS）：中位PFS为53.1个月，%3年PFS为62.9％（45.2-76.3）。在多变量分析中，仅手术前放疗对3年PFS有显著影响(95%CI0.929-12.994,p=0.0643).结论：这项研究的结果表明，没有内脏转移和积极的手术作为整体，在可行的情况下，能延长患者的生存率,提高患者的生活质量。
