Prognostic factors and its predictive value in patients with metastatic spinal cancer

BACKGROUND The spine is the most common location of metastatic diseases.Treating a metastatic spinal tumor depends on many factors,including patients’overall health and life expectancy.The present study was conducted to investigate prognostic factors and clinical outcomes in patients with vertebral metastases.AIM To investigate prognostic factors and their predictive value in patients with metastatic spinal cancer.METHODS A retrospective analysis of 109 patients with metastatic spinal cancer was conducted between January 2015 and September 2017.The prognoses and survival were analyzed,and the effects of factors such as clinical features,treatment methods,primary lesions and affected spinal segments on the prognosis of patients with metastatic spinal cancer were discussed.The prognostic value of Frankel spinal cord injury functional classification scale,metastatic spinal cord compression(MSCC),spinal instability neoplastic score(SINS)and the revised Tokuhashi score for prediction of prognosis was explored in patients with metastatic spinal tumors.RESULTS Age,comorbidity of metastasis from elsewhere,treatment methods,the number of spinal tumors,patient’s attitude toward tumors and Karnofsky performance scale score have an effect on the prognosis of patients(all P<0.05).With respect to classification of spinal cord injury,before operation,the proportion of grade B and grade C was higher in the group of patients who died than in the group of patients who survived,and that of grade D and grade E was lower in the group of patients who died than in the group of patients who survived(all P<0.05).At 1 mo after operation,the proportion of grade A,B and C was higher in the group of patients who died than in the group of patients who survived,and that of grade E was lower in patients in the group of patients who died than in the group of patients who survived(all P<0.05).MSCC occurred in four(14.3%)patients in the survival group and 17(21.0%)patients in the death group(P<0.05).All patients suffered from intractable pain,dysfunction in spinal cord and even paralysis.The proportion of SINS score of 1 to 6 points was lower in the death group than in the survival group,and the proportion of SINS score of 7 to 12 points was higher in the death group than in the survival group(all P<0.05).The proportion of revised Tokuhashi score of 0 to 8 points and 9 to 11 points were higher in the death group than in the survival group,and the proportion of revised Tokuhashi score of 12 to 15 points was lower in the death group than in the survival group(all P<0.05).Frankel spinal cord injury functional classification scale,MSCC,SINS and revised Tokuhashi score were important factors influencing the surgical treatment of patients with metastatic spinal cancer(all P<0.05).CONCLUSION Frankel spinal cord injury functional classification scale,MSCC,SINS and revised Tokuhashi score were helpful in predicting the prognosis of patients with metastatic spinal cancer.

36例老年肺结核误诊情况分析

为探讨老年肺结核的误诊原因,笔者回顾性分析2012年10月至2018年9月孝感市结核病防治所收住入院的36例≥60岁老年肺结核患者的临床资料,其中11例由本所误诊,25例来本所住院之前由综合医院误诊。在36例老年肺结核中,4例结核瘤误诊为周围型肺癌,5例支气管结核误诊为支气管哮喘,4例支气管结核伴肺不张误诊为中央型肺癌,1例支气管结核伴肺不张误诊为炎性肺不张,2例急性血行播散性肺结核误诊为肺泡癌,5例干酪性肺炎误诊为大叶性肺炎,3例以间质改变为主的肺结核误诊为间质性肺炎,3例空洞内可见液平的肺结核误诊为肺脓肿,4例团块状肺部阴影伴厚壁不规则空洞性肺结核误诊为肺癌,5例顽固性结核性胸腔积液误诊为癌性胸腔积液。老年肺结核由于临床特征不典型,容易误诊,故临床医生应予以足够重视。