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.
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。