预期寿命估计对脊柱转移瘤手术选择与预后预测的临床意义

Estimation of Life Expectancy for Selecting Surgical Procedure and Predicting Prognosis of Extradural Spinal Metastases

背景与目的:目前,临床上对脊柱转移瘤患者是否采取手术治疗以及如何选择手术仍然存在较大的争议。预期寿命的估计是手术选择的决定因素之一。本研究旨在评价Tokuhashi和Tomita评分系统这两种常用的预期寿命估计方法对硬膜外脊柱转移瘤患者手术选择与预后预测的临床价值。方法:对2001年1月至2004年4月丹麦奥胡斯大学医院脊柱外科中心收治的169例硬膜外脊柱转移瘤入组患者,术前用Tokuhashi与Tomita评分系统进行评分以及估计预期寿命,并结合Tomita脊柱肿瘤分型,选择实施手术分级治疗。术后6个月、12个月以及24个月分别进行前瞻性随访观察。对在预期寿命为“3个月内死亡”、“6个月内死亡”以及“12个月内死亡”的患者通过Tokuhashi与Tomita评分系统绘制受试者作业特征曲线(receiveroperatingcharacteristiccurves,ROC曲线),比较两个评分系统对预期寿命估计的准确性。同时采用Kaplan-Meier生存曲线分析法,计算Tokuhashi和Tomita评分系统各分数段患者术后的实际平均生存时间。结果:预期寿命分别为“3个月内死亡”、“6个月内死亡”以及“12个月内死亡”的病例ROC曲线分析显示,Tomita评分系统与Tokuhashi评分系统之间的差异均无显著性(各组P值分别为0.16、0.47与0.38)。Kaplan-Meier生存曲线分析显示,Tomita评分系统在4～7分之间对预后估计过高,Tokuhashi评分系统在0～8分之间对预后估计过低。结论:Tokuhashi和Tomita评分系统均可成功地预测脊柱转移瘤患者术后预后的情况。Tokuhashi评分系统可较为准确地预测生存期较短的患者,从而避免对这类患者做不必要的大手术。

BACKGROUND ＆ OBJECTIVE：Clinically, whether and how to make a surgical interventional decision for the patients with spinal metastases is still controversial. Life expectancy is a significant determinant in the selection of surgical procedure for spinal metastases. This study was to evaluate Tomita and Tokuhashi scoring systems in selecting surgical procedure and predicting prognosis of extradural spinal metastases. METHODS. A total of 169 patients with spinal metastases, treated in the Spine Unit of Aarhus University Hospital, Denmark, from Jan. 2001 to Apr. 2004, were enrolled. The life expectancy was scored according to both Tomita system and Tokuhashi system before operation, the spinal metastases were classified according to Tomita system, and the patients underwent surgery accordingly. Follow-up was done 6, 12, and 24 months after operation. The precise of Tomita system and Tokuhashi system in estimating ＂death within 3 months＂, ＂death within 6 months＂, and ＂death within 12 months＂ was compared using Receiver Operating Characteristic curves （ROC curves）. The mean survival time of the patients was calculated by Kaplan-Meier method. RESULTS. ROC curves of ＂death within 3 months＂, ＂death within 6 months＂, and ＂death within 12 months＂ showed no significant difference between Tomita score and Tokuhashi score in each group （P = 0.16, P = 0.47, and P = 0.38, respectively）. Kaplan-Meier survival curves showed that Tomita system overestimated the prognosis in scores from 4 to 7, and Tokuhashi system underestimated the prognosis in scores from 0 to 8. CONCLUSIONS： Both Tomita and Tokuhashi scoring systems could be used to predict prognosis of spinal metastases after operation. Tokuhash accurately, which can be scoring system can predict early death more used to avoid major operation for these patients.