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Abstract：
OBJECTIVE: We endeavored to introduce a novel scoring system (Lumbar Functional Index, LFI) capable of evaluating lumbar function in pelvic bone sarcoma patients who underwent surgical resection and spinal pelvic fixation, while simultaneously identifying the incidence, outcomes, and risk factors of lumbar function impairment among these populations.
METHODS: A cohort of 304 primary bone sarcoma patients were recruited. The LFI was created based on the Oswestry Dysfunction Index (ODI) and Japanese Orthopaedic Association (JOA) scores. Lumbar function impairment was defined as LFI score ≥ 18 points, which was identified as high LFI. Demographic data, clinical characteristics, and oncological outcomes were analyzed.
RESULTS: The cohort included chondrosarcoma (39.8%), osteosarcoma (29.9%), Ewing sarcoma (8.6%), bone-derived undifferentiated pleomorphic sarcoma (7.2%), giant cell tumor of bone (7.2%), chordoma (2.3%), and other bone sarcomas (5.0%). The LFI score exhibited significant negative correlation with common scoring systems of bone sarcoma. The incidence of high LFI was 23.0%. Patients with high LFI demonstrated a higher prevalence of type I + II + III + IV pelvic tumor, more sacrificed nerve roots and bilateral lumbar spine fixation during surgery, while lower percentage of R0 resection and local control of pelvic tumor. Decreased median overall survival (30 vs. 52 months, p < 0.001) and recurrence-free survival (14 vs. 24 months, p < 0.001) time were observed in these patients. Type I + II + III + IV pelvic tumor and sacrificed nerve roots≥2 were identified as risk factors for high LFI, while R0 resection and local control were identified as protective factors.
CONCLUSIONS: The LFI scoring system exhibited a significant negative correlation to current scoring systems. High LFI patients had worse prognosis and distinct characteristics. The risk factors of high LFI included type I + II + III + IV pelvic tumor and sacrificed nerve roots≥2, and the protective factors included R0 resection and local control.
METHODS: A cohort of 304 primary bone sarcoma patients were recruited. The LFI was created based on the Oswestry Dysfunction Index (ODI) and Japanese Orthopaedic Association (JOA) scores. Lumbar function impairment was defined as LFI score ≥ 18 points, which was identified as high LFI. Demographic data, clinical characteristics, and oncological outcomes were analyzed.
RESULTS: The cohort included chondrosarcoma (39.8%), osteosarcoma (29.9%), Ewing sarcoma (8.6%), bone-derived undifferentiated pleomorphic sarcoma (7.2%), giant cell tumor of bone (7.2%), chordoma (2.3%), and other bone sarcomas (5.0%). The LFI score exhibited significant negative correlation with common scoring systems of bone sarcoma. The incidence of high LFI was 23.0%. Patients with high LFI demonstrated a higher prevalence of type I + II + III + IV pelvic tumor, more sacrificed nerve roots and bilateral lumbar spine fixation during surgery, while lower percentage of R0 resection and local control of pelvic tumor. Decreased median overall survival (30 vs. 52 months, p < 0.001) and recurrence-free survival (14 vs. 24 months, p < 0.001) time were observed in these patients. Type I + II + III + IV pelvic tumor and sacrificed nerve roots≥2 were identified as risk factors for high LFI, while R0 resection and local control were identified as protective factors.
CONCLUSIONS: The LFI scoring system exhibited a significant negative correlation to current scoring systems. High LFI patients had worse prognosis and distinct characteristics. The risk factors of high LFI included type I + II + III + IV pelvic tumor and sacrificed nerve roots≥2, and the protective factors included R0 resection and local control.
摘要：
目标：我们努力引入一种新颖的评分系统（腰椎功能指数，LFI）能够评估接受手术切除和脊柱骨盆固定的骨盆骨肉瘤患者的腰椎功能，在确定发病率的同时，结果，以及这些人群中腰椎功能损害的危险因素。
方法：招募了304例原发性骨肉瘤患者。LFI是根据Oswestry功能障碍指数（ODI）和日本骨科协会（JOA）评分创建的。腰椎功能损害定义为LFI评分≥18分，被鉴定为高LFI。人口统计数据,临床特征,和肿瘤学结果进行了分析。
结果：队列包括软骨肉瘤（39.8%），骨肉瘤（29.9%），尤因肉瘤(8.6%),骨源性未分化多形性肉瘤（7.2%），骨巨细胞瘤(7.2%),脊索瘤(2.3%),和其他骨肉瘤（5.0％）。LFI评分与骨肉瘤常见评分系统呈显著负相关。高LFI发生率为23.0%。高LFI患者表现出I+II+III+IV型盆腔肿瘤患病率较高，术中牺牲更多的神经根和双侧腰椎固定，而R0切除和盆腔肿瘤局部控制的百分比较低。中位总生存期降低（30vs.52个月,p<0.001）和无复发生存率（14vs.24个月,在这些患者中观察到p<0.001）时间。I+II+III+IV型盆腔肿瘤和处死神经根≥2为高LFI的危险因素，而R0切除和局部控制被确定为保护因素。
结论：LFI评分系统与现有评分系统呈显著负相关。高LFI患者预后较差，特点明显。高LFI的危险因素包括I+II+III+IV型盆腔肿瘤和神经根处死≥2，保护因素包括R0切除和局部控制。
方法：招募了304例原发性骨肉瘤患者。LFI是根据Oswestry功能障碍指数（ODI）和日本骨科协会（JOA）评分创建的。腰椎功能损害定义为LFI评分≥18分，被鉴定为高LFI。人口统计数据,临床特征,和肿瘤学结果进行了分析。
结果：队列包括软骨肉瘤（39.8%），骨肉瘤（29.9%），尤因肉瘤(8.6%),骨源性未分化多形性肉瘤（7.2%），骨巨细胞瘤(7.2%),脊索瘤(2.3%),和其他骨肉瘤（5.0％）。LFI评分与骨肉瘤常见评分系统呈显著负相关。高LFI发生率为23.0%。高LFI患者表现出I+II+III+IV型盆腔肿瘤患病率较高，术中牺牲更多的神经根和双侧腰椎固定，而R0切除和盆腔肿瘤局部控制的百分比较低。中位总生存期降低（30vs.52个月,p<0.001）和无复发生存率（14vs.24个月,在这些患者中观察到p<0.001）时间。I+II+III+IV型盆腔肿瘤和处死神经根≥2为高LFI的危险因素，而R0切除和局部控制被确定为保护因素。
结论：LFI评分系统与现有评分系统呈显著负相关。高LFI患者预后较差，特点明显。高LFI的危险因素包括I+II+III+IV型盆腔肿瘤和神经根处死≥2，保护因素包括R0切除和局部控制。
