Rades评分和Tomita评分在预测脊柱转移瘤患者预后的应用比较

Comparison of Rades score and Tomita score in predicting the prognosis of patients with spinal metastasis

目的 比较Rades评分和Tomita评分预测脊柱转移瘤患者临床预后的准确性。方法 回顾2010年1月至2020年12月我院骨科收治的脊柱转移瘤住院患者127例,收集病历资料,随访至2022年6月30日,计算Rades评分和Tomita评分,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 患者中位生存时间为10个月,随访期内死亡占比76.38%(97/127),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分的患者平均生存时间分别为(7.0±2.6)、(11.7±2.3)和(17.7±4.7)个月,Tomita评分2~3分、4~5分、6~7分和8~9分的患者生存时间分别为(18.5±4.7)、(11.9±2.2)、(8.4±3.0)和(5.5±1.5)个月。Rades评分和Tomita评分预测患者生存时间的ROC曲线下面积分别为0.931和0.928,最佳截断值为36.5和4.5。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至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HR分别为41.871和4.728,肺癌和其它癌症相对于骨髓瘤/淋巴瘤的HR分别为10.039和8.475,治疗前能自由活动的HR为0.703,无内脏转移的HR为0.606,肿瘤诊断至发生脊柱转移时间> 15个月的HR为0.496 (P均<0.05)。Tomita评分和KPS评分与患者生存时间有关,Tomita评分4~5分、6~7分和8~9分(相比于2~3分)的HR分别为8.506、25.284和84.590,KPS评分50~70分和≥80分(相比于≤40分)的HR分别为0.226和0.129。结论 脊柱转移瘤患者预后差,Rades评分和Tomita评分对预测患者预后有一定价值,可作为治疗方式选择的参考依据。

Objective To compare the accuracy of Rades score and Tomita score in predicting the clinical prognosis of patients with spinal metastases.Methods A total of 127 patients with spinal metastases admitted to the Department of Orthopaedics of the First People’s Hospital of Yibin from January 2010 to December 2020 were reviewed.Their medical records were collected and followed up to June 30,2022.Rades score and Tomita score were calculated.Kaplan-Meier method was used to draw the survival curve.Log-rank test and Cox regression were used to analyze the factors affecting the prognosis of patients.Results The median survival time of the patients was 10 months,with a mortality rate of 76.38%(97/127)during the follow-up period.The 6-month and 12-month survival rates were 69.29%and 27.56%,respectively.The average survival time of patients with Rades scores of 20 to 30,31 to 35,and≥36 was(7.0±2.6),(11.7±2.3),and(17.7±4.7)months,respectively.The survival time of patients with Tomita scores of 2 to 3,4 to 5,6 to 7,and 8 to 9 was(18.5±4.7),(11.9±2.2),(8.4±3.0),and(5.5±1.5)months,respectively.The area under the receiver operating characteristic curve predicted by Rades score and Tomita score was 0.931 and 0.928,respectively,with the best cut-off values at 36.5 and 4.5.Cox regression showed that the Rades score,primary tumor type,freedom of movement before treatment,presence or absence of visceral metastasis,and time from tumor diagnosis to spinal metastasis were influencing factors for the prognosis of spinal metastasis.The Rades scores of 20 to 30 and 31 to 35(compared to Rades score≥36)were 41.871 and 4.728,respectively.The HR of lung cancer and other cancers relative to myeloma/lymphoma was 10.039 and 8.475,respectively,and the HR of freedom of movement before treatment was 0.703.The HR without visceral metastasis was 0.606,and the HR for tumors diagnosed with spinal metastasis>15 months was 0.496(P<0.05).The Tomita score and KPS score were related to survival time of patients.The HR for Tomita scores of 4 to 5,6 to 7,and 8 to 9(compared to 2 to 3)were 8.506,25.284,and 84.590,respectively.The HR for KPS scores of 50 to 70 and≥80(compared to≤40)were 0.226 and 0.129,respectively.Conclusions Patients with spinal metastasis have poor prognosis,and the Rades score and Tomita score have certain value in predicting patient prognosis,which can serve as a reference to select treatment methods.