Abstract：
OBJECTIVE: In patients undergoing metastatic spine surgery, we sought to 1) report time to postoperative radiation therapy (RT), 2) describe the predictive factors of time to postoperative RT, and 3) determine if earlier postoperative RT is associated with improved local recurrence (LR) and overall survival (OS).
METHODS: A single-center retrospective cohort study was undertaken of all patients undergoing spine surgery for extradural metastatic disease and receiving RT within 3 months postoperatively between January 2010 and January 2021. Time to postoperative RT was dichotomized at <1 month versus 1-3 months. The primary outcomes were LR, OS, and 1-year survival. Secondary outcomes were wound complication, Karnofsky Performance Status, and modified McCormick Scale (MMS) score. Regression analyses controlled for age, body mass index, tumor size, preoperative RT, preoperative/postoperative chemotherapy, and type of RT.
RESULTS: Of 76 patients undergoing spinal metastasis surgery and receiving postoperative RT within 3 months, 34 (44.7%) received RT within 1 month and 42 (55.2%) within 1-3 months. Patients with larger tumor size (β = -3.58; 95% confidence interval [CI], -6.59 to -0.57; P = 0.021) or new neurologic deficits (β = -16.21; 95% CI, -32.21 to -0.210; P = 0.047) had a shorter time to RT. No significant association was found between time to RT and LR or OS on multivariable logistic/Cox regression. However, patients who received RT between 1 and 3 months had a lower odds of 1-year survival compared with those receiving RT within 1 month (odds ratio, 0.18; 95% CI, 0.04-0.74; P = 0.022). Receiving RT within 1 month versus 1-3 months was not associated with wound complications (7.1% vs. 2.9%; P = 0.556) (odds ratio, 4.40; 95% CI, 0.40-118.0; P = 0.266) or Karnofsky Performance Status/modified McCormick Scale score.
CONCLUSIONS: Spine surgeons, oncologists, and radiation oncologists should make every effort to start RT within 1 month to improve 1-year survival after metastatic spine tumor surgery.
METHODS: A single-center retrospective cohort study was undertaken of all patients undergoing spine surgery for extradural metastatic disease and receiving RT within 3 months postoperatively between January 2010 and January 2021. Time to postoperative RT was dichotomized at <1 month versus 1-3 months. The primary outcomes were LR, OS, and 1-year survival. Secondary outcomes were wound complication, Karnofsky Performance Status, and modified McCormick Scale (MMS) score. Regression analyses controlled for age, body mass index, tumor size, preoperative RT, preoperative/postoperative chemotherapy, and type of RT.
RESULTS: Of 76 patients undergoing spinal metastasis surgery and receiving postoperative RT within 3 months, 34 (44.7%) received RT within 1 month and 42 (55.2%) within 1-3 months. Patients with larger tumor size (β = -3.58; 95% confidence interval [CI], -6.59 to -0.57; P = 0.021) or new neurologic deficits (β = -16.21; 95% CI, -32.21 to -0.210; P = 0.047) had a shorter time to RT. No significant association was found between time to RT and LR or OS on multivariable logistic/Cox regression. However, patients who received RT between 1 and 3 months had a lower odds of 1-year survival compared with those receiving RT within 1 month (odds ratio, 0.18; 95% CI, 0.04-0.74; P = 0.022). Receiving RT within 1 month versus 1-3 months was not associated with wound complications (7.1% vs. 2.9%; P = 0.556) (odds ratio, 4.40; 95% CI, 0.40-118.0; P = 0.266) or Karnofsky Performance Status/modified McCormick Scale score.
CONCLUSIONS: Spine surgeons, oncologists, and radiation oncologists should make every effort to start RT within 1 month to improve 1-year survival after metastatic spine tumor surgery.
摘要：
目标：在接受脊柱转移性手术的患者中，我们力求：1）报告术后放射治疗（RT）的时间，2)描述术后放疗时间的预测因素，和3）确定术后早期RT是否与改善的局部复发（LR）和总生存期（OS）相关。
方法：单中心，我们对所有因硬膜外转移性疾病而接受脊柱手术并在术后3个月内接受RT的患者进行回顾性队列研究。术后RT的时间在<1个月与1-3个月。主要结果是LR，操作系统,和1年生存率。次要结果是伤口并发症，Karnofsky绩效量表(KPS)，和改良麦考密克量表（MMS）。按年龄控制的回归分析，BMI,肿瘤大小,术前RT,术前/术后化疗，RT的类型。
结果：76例脊柱转移瘤患者在3个月内接受术后放疗，34例（44.7%）在1个月内接受RT，42例（55.2%）在1-3个月内接受RT。肿瘤大小较大(β=-3.58,95CI=-6.59,-0.57,p=0.021)或新出现的神经功能缺损(β=-16.21,95CI=-32.21,-0.210,p=0.047)的患者接受放疗的时间较短。在多变量逻辑/Cox回归中，RT时间与LR或OS之间没有发现显着关联。然而,与1个月内接受RT的患者相比,接受RT1~3个月的患者1年生存率较低(OR=0.18,95CI=0.04~0.74,p=0.022).1个月内收到RTvs.1-3个月与伤口并发症无关(7.1%vs.2.9%,p=0.556)(OR=4.40,95CI=0.40-118.0,p=0.266)或KPS/MMS。
结论：脊柱外科医生，肿瘤学家,放射肿瘤学家应尽一切努力在1个月内开始放疗，以提高脊柱转移性肿瘤手术后的1年生存率。
方法：单中心，我们对所有因硬膜外转移性疾病而接受脊柱手术并在术后3个月内接受RT的患者进行回顾性队列研究。术后RT的时间在<1个月与1-3个月。主要结果是LR，操作系统,和1年生存率。次要结果是伤口并发症，Karnofsky绩效量表(KPS)，和改良麦考密克量表（MMS）。按年龄控制的回归分析，BMI,肿瘤大小,术前RT,术前/术后化疗，RT的类型。
结果：76例脊柱转移瘤患者在3个月内接受术后放疗，34例（44.7%）在1个月内接受RT，42例（55.2%）在1-3个月内接受RT。肿瘤大小较大(β=-3.58,95CI=-6.59,-0.57,p=0.021)或新出现的神经功能缺损(β=-16.21,95CI=-32.21,-0.210,p=0.047)的患者接受放疗的时间较短。在多变量逻辑/Cox回归中，RT时间与LR或OS之间没有发现显着关联。然而,与1个月内接受RT的患者相比,接受RT1~3个月的患者1年生存率较低(OR=0.18,95CI=0.04~0.74,p=0.022).1个月内收到RTvs.1-3个月与伤口并发症无关(7.1%vs.2.9%,p=0.556)(OR=4.40,95CI=0.40-118.0,p=0.266)或KPS/MMS。
结论：脊柱外科医生，肿瘤学家,放射肿瘤学家应尽一切努力在1个月内开始放疗，以提高脊柱转移性肿瘤手术后的1年生存率。
