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Abstract：
OBJECTIVE: Lumbosacral vertebral osteoblastic metastasis is treated with percutaneous vertebroplasty (PVP) combined with 125I seed implantation and PVP alone. Compared to PVP alone, we evaluated the effects of combination therapy with PVP and 125I seed implantation on pain, physical condition, and survival and evaluated the clinical value of PVP combined with 125I particle implantation.
METHODS: We retrospectively analyzed 62 patients with lumbosacral vertebral osseous metastases treated at our hospital between 2016 and 2019. All the patients met the inclusion criteria for 125I implantation, and they were randomly divided into a combined treatment group and a pure PVP surgery group. The visual analog pain scale (VAS), Karnofsky Performance Status (KPS), and survival time were recorded at different time points, including preoperative, postoperative 1 day, 1 month, 3 months, 6 months, 12 months, and 36 months in each group. The variation in clinical indicators and differences between the groups were analyzed using SPSS version 20.0. Correlations between different variables were analyzed using the nonparametric Spearman\'s rank test. The Kaplan-Meier method was used to estimate the relationship between survival time and KPS score, VAS score, or primary tumor progression, and survival differences were analyzed using the log-rank test. Multivariate analyses were performed using a stepwise Cox proportional hazards model to identify independent prognostic factors.
RESULTS: Compared to the PVP treatment group, the pain level in the combined treatment group was significantly reduced (P = 0.000), and the patient\'s physical condition in the combination treatment group significantly improved. Kaplan-Meier analysis showed that the survival rate of the PVP group was significantly lower than that of the combination group (P = 0.038). We also found that the median survival of patients in both groups significantly increased with an increase in the KPS score (14 months vs. 33 months) (P = 0.020). Patients with more than three transfer sections had significantly lower survival rates than those with one or two segments of the section (P = 0.001). Further, Cox regression analysis showed that age (P = 0.002), the spinal segment for spinal metastasis (P = 0.000), and primary tumor growth rate (P = 0.005) were independent factors that affected the long-term survival of patients with lumbosacral vertebral osseous metastases.
CONCLUSIONS: PVP combined 125I seeds implantation surgery demonstrated superior effectiveness compared to PVP surgery alone in treating lumbosacral vertebral osseous metastases, which had feasibility in the clinical operation. Preoperative KPS score, spine transfer section, and primary tumor growth rate were closely related to the survival of patients with lumbosacral vertebral osteoblastic metastasis. Age, spinal segment for spinal metastasis, and primary tumor growth can serve as prognostic indicators and guide clinical treatment.
METHODS: We retrospectively analyzed 62 patients with lumbosacral vertebral osseous metastases treated at our hospital between 2016 and 2019. All the patients met the inclusion criteria for 125I implantation, and they were randomly divided into a combined treatment group and a pure PVP surgery group. The visual analog pain scale (VAS), Karnofsky Performance Status (KPS), and survival time were recorded at different time points, including preoperative, postoperative 1 day, 1 month, 3 months, 6 months, 12 months, and 36 months in each group. The variation in clinical indicators and differences between the groups were analyzed using SPSS version 20.0. Correlations between different variables were analyzed using the nonparametric Spearman\'s rank test. The Kaplan-Meier method was used to estimate the relationship between survival time and KPS score, VAS score, or primary tumor progression, and survival differences were analyzed using the log-rank test. Multivariate analyses were performed using a stepwise Cox proportional hazards model to identify independent prognostic factors.
RESULTS: Compared to the PVP treatment group, the pain level in the combined treatment group was significantly reduced (P = 0.000), and the patient\'s physical condition in the combination treatment group significantly improved. Kaplan-Meier analysis showed that the survival rate of the PVP group was significantly lower than that of the combination group (P = 0.038). We also found that the median survival of patients in both groups significantly increased with an increase in the KPS score (14 months vs. 33 months) (P = 0.020). Patients with more than three transfer sections had significantly lower survival rates than those with one or two segments of the section (P = 0.001). Further, Cox regression analysis showed that age (P = 0.002), the spinal segment for spinal metastasis (P = 0.000), and primary tumor growth rate (P = 0.005) were independent factors that affected the long-term survival of patients with lumbosacral vertebral osseous metastases.
CONCLUSIONS: PVP combined 125I seeds implantation surgery demonstrated superior effectiveness compared to PVP surgery alone in treating lumbosacral vertebral osseous metastases, which had feasibility in the clinical operation. Preoperative KPS score, spine transfer section, and primary tumor growth rate were closely related to the survival of patients with lumbosacral vertebral osteoblastic metastasis. Age, spinal segment for spinal metastasis, and primary tumor growth can serve as prognostic indicators and guide clinical treatment.
摘要：
目的：经皮椎体成形术（PVP）联合125I粒子植入和单纯PVP治疗腰骶部椎体成骨细胞转移瘤。与单纯的PVP相比，我们评估了PVP和125I粒子植入联合治疗对疼痛的影响，身体状况,并评价PVP联合125I粒子植入的临床价值。
方法：回顾性分析我院2016-2019年收治的62例腰骶椎骨性转移瘤患者的临床资料。所有患者均符合125I植入的纳入标准，随机分为联合治疗组和单纯PVP手术组。视觉模拟疼痛量表(VAS)Karnofsky绩效状态（KPS），在不同的时间点记录生存时间，包括术前,术后1天,1个月,3个月,6个月,12个月,每组36个月。采用SPSS20.0版分析临床指标的变异及组间差异。使用非参数Spearman秩检验分析不同变量之间的相关性。采用Kaplan-Meier法估计生存时间与KPS评分的关系,VAS评分,或原发性肿瘤进展，和生存差异使用对数秩检验进行分析。使用逐步Cox比例风险模型进行多变量分析，以确定独立的预后因素。
结果：与PVP治疗组相比，联合治疗组疼痛程度明显减轻(P=0.000),联合治疗组患者的身体状况明显改善。Kaplan-Meier分析显示,PVP组的生存率显著低于联合组(P=0.038)。我们还发现，随着KPS评分的增加，两组患者的中位生存期显着增加(14个月vs.33个月)(P=0.020)。具有三个以上转移切片的患者的生存率明显低于具有一个或两个切片的患者（P=0.001）。Further,Cox回归分析显示年龄(P=0.002),脊柱节段为脊柱转移瘤(P=0.000),原发肿瘤生长速率(P=0.005)是影响腰骶椎骨性转移瘤患者长期生存的独立因素。
结论：PVP联合125I粒子植入手术治疗腰骶椎骨性转移瘤的疗效优于单纯PVP手术，在临床操作中具有可行性。术前KPS评分,脊柱转移部分,原发性肿瘤的生长速度与腰骶椎骨转移瘤患者的生存率密切相关。年龄,脊柱转移的脊柱节段，原发肿瘤的生长可以作为预后指标,指导临床治疗。
方法：回顾性分析我院2016-2019年收治的62例腰骶椎骨性转移瘤患者的临床资料。所有患者均符合125I植入的纳入标准，随机分为联合治疗组和单纯PVP手术组。视觉模拟疼痛量表(VAS)Karnofsky绩效状态（KPS），在不同的时间点记录生存时间，包括术前,术后1天,1个月,3个月,6个月,12个月,每组36个月。采用SPSS20.0版分析临床指标的变异及组间差异。使用非参数Spearman秩检验分析不同变量之间的相关性。采用Kaplan-Meier法估计生存时间与KPS评分的关系,VAS评分,或原发性肿瘤进展，和生存差异使用对数秩检验进行分析。使用逐步Cox比例风险模型进行多变量分析，以确定独立的预后因素。
结果：与PVP治疗组相比，联合治疗组疼痛程度明显减轻(P=0.000),联合治疗组患者的身体状况明显改善。Kaplan-Meier分析显示,PVP组的生存率显著低于联合组(P=0.038)。我们还发现，随着KPS评分的增加，两组患者的中位生存期显着增加(14个月vs.33个月)(P=0.020)。具有三个以上转移切片的患者的生存率明显低于具有一个或两个切片的患者（P=0.001）。Further,Cox回归分析显示年龄(P=0.002),脊柱节段为脊柱转移瘤(P=0.000),原发肿瘤生长速率(P=0.005)是影响腰骶椎骨性转移瘤患者长期生存的独立因素。
结论：PVP联合125I粒子植入手术治疗腰骶椎骨性转移瘤的疗效优于单纯PVP手术，在临床操作中具有可行性。术前KPS评分,脊柱转移部分,原发性肿瘤的生长速度与腰骶椎骨转移瘤患者的生存率密切相关。年龄,脊柱转移的脊柱节段，原发肿瘤的生长可以作为预后指标,指导临床治疗。
