PDF(Pubmed)
Abstract：
BACKGROUND: One important determinant in choosing a treatment modality is spinal instability. Clear management guidelines are suggested for stable and unstable spinal metastatic lesions, but lesions in the intermediate instability category (SINS [spinal instability neoplastic score] score of 7-12) remain a clinical dilemma. This study aims to analyze the risk factors necessitating surgical intervention after radiotherapy (RT) in patients with those lesions.
METHODS: A multicenter cohort of 469 patients with spinal metastases of intermediate instability who received radiotherapy (RT) as the initial treatment between 2019 and 2021 were retrospectively enrolled. All patients were neurologically intact at the time of RT. According to the performance of surgical intervention after RT, various clinical and radiographic risk factors for surgical intervention were compared between surgery and non-surgery groups using uni- and multivariate analyses. A recursive partitioning analysis (RPA) was performed using significant determinants identified in multivariate analysis.
RESULTS: The mean age at the time of RT was 59.9 years and there were 198 females. The lung was the most common primary site. During the mean follow-up duration of 18.2 months, surgical treatment was required in 79 (17.9%) of patients. The most common surgical method was decompressive laminectomy with stabilization (62.0%), followed by vertebrectomy with stabilization (22.8%) and stabilization only (15.2%). The mean SINS for the total cohort was 9.0. Multivariate regression analyses revealed that the primary tumor site of the lung, liver, and kidney, higher Bilsky grades of ESCC, lytic bone lesions, and higher EQD210 were significant risk factors for surgical intervention after RT. Among them, Bilsky grade, primary tumor type of the lung, liver, and kidney, and EQD210 were the most important determinants for expecting the probability of surgical intervention on RPA.
CONCLUSIONS: Surgical intervention was performed in 17.9% of patients with intermediate instability after RT as the initial treatment. The primary tumor site of the lung, liver, and kidney, higher Bilsky grade of ESCC, and EQD210 were the most important determinants for expecting the probability of surgical intervention. Therefore, the optimal treatment strategy needs to be devised by carefully evaluating the risk of surgical intervention.
METHODS: A multicenter cohort of 469 patients with spinal metastases of intermediate instability who received radiotherapy (RT) as the initial treatment between 2019 and 2021 were retrospectively enrolled. All patients were neurologically intact at the time of RT. According to the performance of surgical intervention after RT, various clinical and radiographic risk factors for surgical intervention were compared between surgery and non-surgery groups using uni- and multivariate analyses. A recursive partitioning analysis (RPA) was performed using significant determinants identified in multivariate analysis.
RESULTS: The mean age at the time of RT was 59.9 years and there were 198 females. The lung was the most common primary site. During the mean follow-up duration of 18.2 months, surgical treatment was required in 79 (17.9%) of patients. The most common surgical method was decompressive laminectomy with stabilization (62.0%), followed by vertebrectomy with stabilization (22.8%) and stabilization only (15.2%). The mean SINS for the total cohort was 9.0. Multivariate regression analyses revealed that the primary tumor site of the lung, liver, and kidney, higher Bilsky grades of ESCC, lytic bone lesions, and higher EQD210 were significant risk factors for surgical intervention after RT. Among them, Bilsky grade, primary tumor type of the lung, liver, and kidney, and EQD210 were the most important determinants for expecting the probability of surgical intervention on RPA.
CONCLUSIONS: Surgical intervention was performed in 17.9% of patients with intermediate instability after RT as the initial treatment. The primary tumor site of the lung, liver, and kidney, higher Bilsky grade of ESCC, and EQD210 were the most important determinants for expecting the probability of surgical intervention. Therefore, the optimal treatment strategy needs to be devised by carefully evaluating the risk of surgical intervention.
摘要：
背景：选择治疗方式的一个重要决定因素是脊柱不稳定。对于稳定和不稳定的脊柱转移性病变，建议明确的管理指南，但中度不稳定类别的病变(SINS[脊柱不稳定肿瘤评分]评分为7-12分)仍然是一个临床难题.本研究旨在分析这些病变患者放疗（RT）后需要手术干预的危险因素。
方法：回顾性纳入了一项多中心队列研究，纳入了469例中度不稳定脊柱转移患者，这些患者在2019年至2021年间接受了放疗（RT）作为初始治疗。所有患者在RT时在神经上都是完整的。根据RT后手术干预的表现，采用单因素和多因素分析比较了手术组和非手术组的各种临床和影像学危险因素.使用在多变量分析中鉴定的重要决定因素进行递归划分分析(RPA)。
结果：RT时的平均年龄为59.9岁，有198名女性。肺是最常见的原发部位。在平均18.2个月的随访期间，79例(17.9%)患者需要手术治疗.最常见的手术方法是稳定的减压椎板切除术（62.0％），其次是稳定的椎骨切除术（22.8％）和仅稳定的椎骨切除术（15.2％）。整个队列的平均SINS为9.0。多因素回归分析显示，肺的原发肿瘤部位，肝脏,和肾脏，ESCC的Bilsky等级更高，溶骨病变，和较高的EQD210是RT后手术干预的重要危险因素。其中,Bilsky等级,肺的原发肿瘤类型,肝脏,和肾脏，和EQD210是预期RPA手术干预概率的最重要决定因素。
结论：在作为初始治疗的RT后，17.9%的中度不稳定患者进行了手术干预。肺的原发肿瘤部位,肝脏,和肾脏，ESCC的Bilsky等级更高，和EQD210是预期手术干预概率的最重要决定因素.因此,需要通过仔细评估手术干预的风险来制定最佳治疗策略.
方法：回顾性纳入了一项多中心队列研究，纳入了469例中度不稳定脊柱转移患者，这些患者在2019年至2021年间接受了放疗（RT）作为初始治疗。所有患者在RT时在神经上都是完整的。根据RT后手术干预的表现，采用单因素和多因素分析比较了手术组和非手术组的各种临床和影像学危险因素.使用在多变量分析中鉴定的重要决定因素进行递归划分分析(RPA)。
结果：RT时的平均年龄为59.9岁，有198名女性。肺是最常见的原发部位。在平均18.2个月的随访期间，79例(17.9%)患者需要手术治疗.最常见的手术方法是稳定的减压椎板切除术（62.0％），其次是稳定的椎骨切除术（22.8％）和仅稳定的椎骨切除术（15.2％）。整个队列的平均SINS为9.0。多因素回归分析显示，肺的原发肿瘤部位，肝脏,和肾脏，ESCC的Bilsky等级更高，溶骨病变，和较高的EQD210是RT后手术干预的重要危险因素。其中,Bilsky等级,肺的原发肿瘤类型,肝脏,和肾脏，和EQD210是预期RPA手术干预概率的最重要决定因素。
结论：在作为初始治疗的RT后，17.9%的中度不稳定患者进行了手术干预。肺的原发肿瘤部位,肝脏,和肾脏，ESCC的Bilsky等级更高，和EQD210是预期手术干预概率的最重要决定因素.因此,需要通过仔细评估手术干预的风险来制定最佳治疗策略.
