Abstract：
Intramedullary spinal cord metastasis (ISCM), though rare, represents a potentially debilitating manifestation of systemic cancer. With emerging advances in cancer care, ISCMs are increasingly being encountered in clinical practice. Herein, we describe one of the larger retrospective single institutional case series on ISCMs, analyze survival and treatment outcomes, and review the literature. All surgically evaluated ISCMs at our institution between 2005 and 2023 were retrospectively reviewed. Demographics, tumor features, treatment, and clinical outcome characteristics were collected. Neurological function was quantified via the Frankel grade and the McCormick score (MCS). The pre- and post-operative Karnofsky performance scores (KPS) were used to assess functional status. Descriptive statistics, univariate analysis, log-rank test, and the Kaplan-Meier survival analysis were performed. A total of 9 patients were included (median age 67 years (range, 26-71); 6 were male). Thoracic and cervical spinal segments were most affected (4 patients each). Six patients (75%) underwent surgical management (1 biopsy and 5 resections), and 3 cases underwent chemoradiation only. Post-operatively, 2 patients had an improvement in their neurological exam with one patient becoming ambulatory after surgery; three patients maintained their neurological exam, and 1 had a decline. There was no statistically significant difference in the pre- and post-operative MCS and median KPS scores in surgically treated patients. Median OS after ISCM diagnosis was 7 months. Absence of brain metastasis, tumor histology (renal and melanoma), cervical/thoracic location, and post-op KPS ≥ 70 showed a trend toward improved overall survival. The incidence of ISCM is increasing, and earlier diagnosis and treatment are considered key for the preservation of neurological function. When patient characteristics are favorable, surgical resection of ISCM can be considered in patients with rapidly progressive neurological deficits. Surgical treatment was not associated with an improvement in overall survival in patients with ISCMs.
摘要：
脊髓髓内转移瘤(ISCM),虽然罕见，代表系统性癌症的潜在衰弱表现。随着癌症治疗的新进展，在临床实践中越来越多地遇到ISCM。在这里，我们描述了一个更大的回顾性单一机构病例系列，分析生存和治疗结果，并回顾文献。我们对2005年至2023年期间在我们机构接受手术评估的所有ISCM进行了回顾性审查。人口统计,肿瘤特征,治疗,收集临床结局特征。通过Frankel等级和McCormick评分（MCS）量化神经功能。术前和术后Karnofsky表现评分（KPS）用于评估功能状态。描述性统计，单变量分析，对数秩检验，并进行了Kaplan-Meier生存分析.共纳入9例患者(中位年龄67岁(范围，26-71）；6人为男性）。胸椎和颈椎节段受影响最大（各4例）。6例患者（75%）接受了手术治疗（1例活检和5例切除），3例仅接受放化疗。术后,2名患者的神经系统检查有所改善，一名患者在手术后开始走动；三名患者保持神经系统检查，1有下降。在手术治疗的患者中，术前和术后的MCS和中位KPS评分没有统计学上的显着差异。ISCM诊断后的中位OS为7个月。没有脑转移，肿瘤组织学（肾和黑色素瘤），颈/胸位置，术后KPS≥70显示出改善总生存期的趋势。ISCM的发病率正在增加，早期诊断和治疗被认为是保持神经功能的关键。当患者特征有利时，对于快速进行性神经功能缺损的患者，可以考虑手术切除ISCM。手术治疗与ISCM患者总生存率的改善无关。
