Objectives: The current study aimed to evaluate the effect of denosumab on patients with impending instability due to spinal metastasis, including whether it can improve spinal instability neoplastic score (SINS) and reduce the need for surgical treatment. Methods: This study retrospectively reviewed patients initially treated non-operatively for metastatic spinal lesions with intermediate SINS (7–12 points) between January 2017 and December 2023 in a single tertiary cancer hospital. Patients were divided into two groups based on the use of denosumab for the intermediate SINS lesion: D-group and N-group. Propensity score matching (PSM) was conducted with a caliper width of 0.025 for the covariates (age, sex, and primary cancer). The study outcomes were (1) the rate of conversion to surgery, (2) the change in SINS, and (3) the change in HU (Hounsfield unit) during the follow-up period. Results: A total of 286 patients (male 151, female 135) with a mean age of 68.0 ± 12.6 years and a mean follow-up period of 37.1 ± 26.5 months were included. Forty-one (14.3%) patients received denosumab (D-group), whereas 245 (85.7%) did not receive denosumab (N-group). Before PSM, 9.8% (4/41) in the D-group and 18.8% (46/245) in the N-group underwent surgical treatment. The rate of conversion to surgery was similar after PSM: the D-group, 8.3% (3/36) vs. the N-group, 16.6% (6/36). Survival analysis using Kaplan–Meier curves also showed that the D-group had a significantly lower probability of conversion to surgery before and after PSM (p= 0.015 andp= 0.023, respectively). In addition, the D-group showed significant improvements in the SINS (total score, pain, and bone lesion scores) and HU after denosumab treatment. Conclusions: In this study, denosumab lowered the rate of conversion to surgery in patients with impending instability (intermediate SINS) due to spinal metastasis. Patients who received denosumab treatment showed significant improvements in the SINS and HU for their metastatic spinal lesions.
目的：本研究旨在评估地舒单抗对因脊柱转移瘤即将发生不稳患者的影响，包括其能否改善脊柱肿瘤不稳评分（SINS）并降低手术治疗需求。方法：本研究回顾性分析了2017年1月至2023年12月期间，在一家三级肿瘤医院因脊柱转移性病灶（SINS评分为7-12分）初始接受非手术治疗的患者。根据是否对中等SINS评分病灶使用地舒单抗，将患者分为两组：D组（使用组）和N组（未使用组）。研究采用倾向性评分匹配法，以0.025的卡钳宽度对协变量（年龄、性别和原发癌类型）进行匹配。研究结局指标包括：（1）转为手术治疗的比率；（2）SINS评分的变化；（3）随访期间HU（亨氏单位）值的变化。结果：共纳入286例患者（男性151例，女性135例），平均年龄为68.0±12.6岁，平均随访时间为37.1±26.5个月。其中41例（14.3%）患者接受了地舒单抗治疗（D组），245例（85.7%）未接受地舒单抗治疗（N组）。在倾向性评分匹配前，D组有9.8%（4/41）的患者转为手术治疗，N组为18.8%（46/245）。匹配后两组转为手术治疗的比率相近：D组为8.3%（3/36），N组为16.6%（6/36）。Kaplan-Meier生存曲线分析显示，无论是在匹配前还是匹配后，D组转为手术治疗的累积概率均显著低于N组（p值分别为0.015和0.023）。此外，D组患者在接受地舒单抗治疗后，其SINS（总分、疼痛评分和骨病灶评分）及HU值均有显著改善。结论：本研究表明，对于因脊柱转移瘤即将发生不稳（中等SINS评分）的患者，地舒单抗能够降低其转为手术治疗的比例。接受地舒单抗治疗的患者，其脊柱转移性病灶的SINS评分和HU值均得到显著改善。
Role of Denosumab in Patients with Intermediate Spinal Instability Neoplastic Score (SINS)
肿瘤(癌症)患者之家