Background: One important determinant in choosing a treatment modality is spinal instability. Clear management guidelines are suggested for stable and unstable spinal metastatic lesions, but lesions in the intermediate instability category (SINS [spinal instability neoplastic score] score of 7–12) remain a clinical dilemma. This study aims to analyze the risk factors necessitating surgical intervention after radiotherapy (RT) in patients with those lesions. Methods: A multicenter cohort of 469 patients with spinal metastases of intermediate instability who received radiotherapy (RT) as the initial treatment between 2019 and 2021 were retrospectively enrolled. All patients were neurologically intact at the time of RT. According to the performance of surgical intervention after RT, various clinical and radiographic risk factors for surgical intervention were compared between surgery and non-surgery groups using uni- and multivariate analyses. A recursive partitioning analysis (RPA) was performed using significant determinants identified in multivariate analysis. Results: The mean age at the time of RT was 59.9 years and there were 198 females. The lung was the most common primary site. During the mean follow-up duration of 18.2 months, surgical treatment was required in 79 (17.9%) of patients. The most common surgical method was decompressive laminectomy with stabilization (62.0%), followed by vertebrectomy with stabilization (22.8%) and stabilization only (15.2%). The mean SINS for the total cohort was 9.0. Multivariate regression analyses revealed that the primary tumor site of the lung, liver, and kidney, higher Bilsky grades of ESCC, lytic bone lesions, and higher EQD210were significant risk factors for surgical intervention after RT. Among them, Bilsky grade, primary tumor type of the lung, liver, and kidney, and EQD210were the most important determinants for expecting the probability of surgical intervention on RPA. Conclusions: Surgical intervention was performed in 17.9% of patients with intermediate instability after RT as the initial treatment. The primary tumor site of the lung, liver, and kidney, higher Bilsky grade of ESCC, and EQD210 were the most important determinants for expecting the probability of surgical intervention. Therefore, the optimal treatment strategy needs to be devised by carefully evaluating the risk of surgical intervention.
背景：选择治疗方式的一个重要决定因素是脊柱稳定性。对于稳定和不稳定的脊柱转移性病变已有明确的管理指南，但处于中间稳定性类别（SINS评分7-12分）的病变仍是临床难题。本研究旨在分析此类病变患者在放疗后需要手术干预的风险因素。 方法：回顾性纳入2019年至2021年间接受放疗作为初始治疗的469例中间稳定性脊柱转移患者的多中心队列。所有患者在放疗时神经功能完好。根据放疗后是否进行手术干预，通过单变量和多变量分析比较手术组与非手术组的各种临床和影像学风险因素。使用多变量分析中确定的显著决定因素进行递归分割分析。 结果：放疗时平均年龄为59.9岁，其中女性198例。肺是最常见的原发部位。在平均18.2个月的随访期间，79例（17.9%）患者需要手术治疗。最常见的手术方式为减压椎板切除加稳定术（62.0%），其次为椎体切除加稳定术（22.8%）和单纯稳定术（15.2%）。全队列平均SINS评分为9.0。多变量回归分析显示，肺、肝、肾原发肿瘤部位、较高的Bilsky硬膜外脊髓压迫分级、溶骨性病变及较高的EQD210是放疗后手术干预的显著风险因素。其中，Bilsky分级、肺/肝/肾原发肿瘤类型及EQD210是RPA中预测手术干预概率的最重要决定因素。 结论：在初始接受放疗的中间稳定性脊柱转移患者中，17.9%最终接受了手术干预。肺/肝/肾原发肿瘤部位、较高的Bilsky硬膜外脊髓压迫分级及EQD210是预测手术干预概率的最重要决定因素。因此，需通过仔细评估手术干预风险来制定最佳治疗策略。
肿瘤(癌症)患者之家