Rades评分在脊柱转移瘤患者临床预后预测中的应用价值

Application of Rades Score in Predicting Clinical Prognosis of Patients with Spinal Metastasis

目的探讨Rades评分在脊柱转移瘤患者临床预后预测中的应用价值。方法回顾性分析2010年1月至2020年12月宜宾市第一人民医院骨科收治的127例脊柱转移瘤住院患者资料,其中男83例,女44例;年龄24~75岁,平均(48.8±11.4)岁,随访临床结局至2022年6月30日,采用Kaplan-Meier法绘制生存曲线,Log-rankχ^(2)检验和Cox回归分析患者预后的影响因素。结果127例患者均获随访,随访时间3~29个月,平均(11.7±4.2)个月,生存时间为(10.2±3.7)个月,随访期内死亡97例,6个月和12个月生存率分别为69.29%和27.56%。Rades评分20~30分、31~35分和≥36分的患者生存时间分别为(7.12±2.66)个月、(11.89±2.22)个月和(17.14±4.91)个月,6个月生存率分别为45.07%、100%和100%,1年生存率分别为1.41%、26.09%和84.85%。Rades评分预测患者生存时间的受试者工作特征曲线(receiver operating characteristic curve,ROC)曲线下面积为0.93,最佳截断值为36.5。Cox回归显示:Rades评分分级、原发肿瘤类型、治疗前能否自由活动、有无内脏转移和肿瘤诊断到脊柱转移时间是脊柱转移瘤预后的影响因素,Rades评分20~30分和31~35分相对于≥36分的风险比(harzard ratio,HR)分别为41.87和4.73,肺癌和其他癌症相对于骨髓瘤或淋巴瘤的HR分别为10.04和8.48,治疗前能自由活动的HR为0.70,无内脏转移的HR为0.61,肿瘤诊断到发生脊柱转移时间>15个月的HR为0.50(P<0.05)。结论脊柱转移瘤患者预后较差,Rades评分系统对患者预后预测有价值,可指导合理选择治疗方式。

Objective To discuss the application value of Rades score in predicting the clinical prognosis of patients with spinal metastasis.Methods From January 2010 to December 2020,127 inpatients,including 83 male and 44 female,aged from 24 to 75 years old with average age(48.8±11.4)years old with spinal metastasis were reviewed from department of orthopedics in the First People’s Hospital of Yibin.We collected the medical records and followed up the clinical outcomes until June 30,2022.The survival curve was drawn by Kaplan-Meier method.Log-rank Chi-square test and Cox regression analysis were used to analyze the factors affecting the prognosis of patients.Results 127 patients were followed up for 3 to 29 months,with an average of(11.7±4.2)months and a survival time of(10.2±3.7)months,and 97 patients died in the follow-up period with 6-month and 12-month survival rates at 69.29%and 27.56%respectively.The survival time of patients with Rades score of 20~30 points,31~35 points and≥36 points was(7.12±2.66),(11.89±2.22)and(17.14±4.91)months,respectively with 6-month survival rate of 45.07%,100%and 100%and 1-year survival rate at 1.41%,26.09%and 84.85%.The area under the receiver operating characteristic(ROC)curve for predicting the prognosis of patients with Rades score was 0.93 with best cut-off value at 36.5 points.Cox regression showed that the Rades score,the type of primary tumor,whether patients could move freely before treatment,visceral metastasis and the duration from tumor diagnosis to spinal metastasis were the possible influencing factors of the prognosis of spinal metastasis.The harzard ratio(HR)of Rades score of 20~30 and 31~35 points were 41.87 and 4.73(compared with≥36 points),respectively.The HR of lung cancer and other cancers relative to myeloma/lymphoma was 10.04 and 8.48,respectively.The HR of free movement before treatment,without visceral metastasis and tumor diagnosis to spinal metastasis>15 months was 0.70,0.61 and 0.50 respectively(P<0.05).Conclusion The prognosis of patients with spinal metastasis is poor,and the Rades score is valuable to predict the prognosis of patients,which can guide the rational selection of treatment methods.