Background. The aim of this study was to assess the surgical outcomes and survival of patients surgically treated for metastatic epidural spinal cord compression (MESCC), with a specific focus on identifying factors that influence overall survival and readmission-free survival. Methods. All patients who underwent surgery for spine metastases at our department in the period 2018–2022 were included in the study. Results. A total of 175 patients (n = 71 females, median age 67.15 years) were included. The most common primary tumors were lung carcinoma (n = 31), prostate carcinoma (n = 31), breast carcinoma (n = 28), multiple myeloma (n = 25), and renal cell carcinoma (n = 11). ECOG performance status was 0 (n = 7), 1 (n = 97), 2 (n = 27), 3 (n = 17), and 4 (n = 27). Pathological fractures were present in n = 108 patients. Decompression only was performed in n = 42, additional instrumentation in n = 133, and vertebral body replacement in n = 23. The most common complications were wound healing deficits and hardware failure. Preoperative motor deficits were present in n = 89 patients. Postoperatively, n = 122 improved, n = 43 was unchanged, and n = 10 deteriorated. Mean overall survival (OS) was 239.2 days, with a 30-day mortality rate of 18.3%. Favorable prognostic factors included Tomita score < 7, Frankel score A–C, ECOG 0–1, and Modified Tokuhashi score > 10 (p< 0.01). Factors affecting OS and readmission-free survival (RFS) included prognostic scores, adjuvant therapy, ASA classification, surgical complications, metastasis number, and postoperative improvement. Better prognostic scores, adjuvant therapy, and clinical improvement were associated with longer OS and RFS, while complications or deterioration resulted in worse outcomes. Conclusions. Patients undergoing decompression and/or stabilization for metastatic spinal tumors showed improved outcomes, with favorable prognosis linked to Tomita score < 7, Frankel score A–C, ECOG 0–1, and Modified Tokuhashi score > 10.
背景：本研究旨在评估接受手术治疗的转移性硬膜外脊髓压迫（MESCC）患者的手术结果与生存情况，重点分析影响患者总生存期及无再入院生存期的相关因素。方法：纳入2018年至2022年间在我科接受脊柱转移瘤手术的所有患者。结果：共纳入175例患者（女性71例，中位年龄67.15岁）。最常见的原发肿瘤为肺癌（31例）、前列腺癌（31例）、乳腺癌（28例）、多发性骨髓瘤（25例）和肾细胞癌（11例）。ECOG体能状态评分为0分（7例）、1分（97例）、2分（27例）、3分（17例）和4分（27例）。108例患者存在病理性骨折。手术方式包括单纯减压术（42例）、减压联合内固定术（133例）及椎体置换术（23例）。最常见的并发症为切口愈合不良和内固定失效。术前存在运动功能障碍者89例；术后122例患者症状改善，43例无变化，10例加重。患者平均总生存期为239.2天，30天死亡率为18.3%。预后良好的相关因素包括Tomita评分＜7分、Frankel分级A–C级、ECOG评分0–1分及改良Tokuhashi评分＞10分（p<0.01）。影响总生存期和无再入院生存期的因素包括预后评分、辅助治疗、ASA分级、手术并发症、转移灶数量及术后神经功能改善情况。较好的预后评分、接受辅助治疗及临床症状改善与更长的总生存期和无再入院生存期相关，而并发症或症状恶化则导致预后较差。结论：接受减压和/或稳定手术的脊柱转移瘤患者临床结局得到改善，其良好预后与Tomita评分＜7分、Frankel分级A–C级、ECOG评分0–1分及改良Tokuhashi评分＞10分显著相关。
肿瘤(癌症)患者之家