基于SINS评分的手术治疗对于脊柱转移癌患者的意义

Significance of SINS-based Surgery on Patients with Spinal Metastatic Carcinoma

目的对于脊柱肿瘤不稳定评分(spinal instability neoplastic score,SINS)≥7分的脊柱转移癌患者,评估采用手术治疗与否对其脊髓功能、体力状态和疼痛等的影响和意义。方法将收治的115例SINS评分≥7分、预计生存期>6月且ECOG活动状态评分≤3分的脊柱转移癌患者,根据是否行脊柱手术分为手术组和非手术组。评估两组患者的脊髓功能、体力状况及骨转移相关疼痛程度。手术组评估时间为术前1周内及术后6月、非手术组评估时间为首次判定SINS评分≥7分和首次评估后6月。结果首次评估时手术组患者脊髓功能(P=0.033)和体力状况(P=0.007)明显差于非手术组,疼痛程度较非手术组严重(P=0.029)。二次评估时手术组患者的脊髓功能和体力状况明显优于非手术组患者(均P<0.001),两组患者疼痛程度差异无统计学意义(P=0.088)。结论对于SINS评分≥7分的患者,手术治疗可以有效保护脊柱转移癌患者的脊髓功能、缓解疼痛,对于维持和改善患者的生活质量具有积极的意义。

Objective To evaluate the effect of surgery on spinal cord function, physical status and pain of the patients with spinal metastatic tumor and spinal cord neoplastic score （SINS）≥7 points. Methods A number of 115 spinal metastatic carcinoma patients with SINS≥7 points, expected survival〉6 months and ECOG score≤3 were included in this study. According to whether or not they had received spinal surgery, the patients were divided into surgery group and non-surgery group. The spinal cord function, physical status and bone metastasis-related pain of the patients were evaluated respectively. In surgery group, the evaluation was performed within one week before surgery and 6 months after surgery. In non-surgery group, the first evaluation was the time when patients were firstly identified SINS score ≥ 7 points and the second evaluation was six months after that. Results At the first evaluation, spinal cord function （P=0.033） and physical condition （P-0.007） in the surgery group were significantly lower than those in the non-surgery group, and the degree of pain was more intense than that in the non-surgery group （P=0.029）. In the second evaluation, spinal cord function and physical condition in the surgery group were significantly better than those in the non-surgery group （both P〈0.001）, and the pain degree was not significantly different between the two groups （P=0.088）. Conclusion For the patients with spinal metastatic carcinoma and SINS score≥7, surgical treatment can effectively protect spinal cord function, relieve pain, maintain physical status, preserve and improve the quality of life.