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| WANG Le,ZHANG Wenwu,LI Tingting.Analysis of factors affecting the prognosis and operative effect of patients with cervical metastasis[J].Chinese Journal of Spine and Spinal Cord,2021,(2):111-119. |
| Analysis of factors affecting the prognosis and operative effect of patients with cervical metastasis |
| Received:October 05, 2020 Revised:February 05, 2021 |
| English Keywords:Surgical treatment Metastatic cancer Prognosis Influencing factors |
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| English Abstract: |
| 【Abstract】 Objectives: To investigate the surgical efficacy, survival prognosis of patients with cervical spine metastasis. Methods: A retrospective analysis was conducted on 72 patients with cervical spine metastasis treated by surgery in our department and followed up from January 2011 to December 2018. There were 47 males and 25 females, aged from 23-78 years old, with an average age of 56.7±12.5 years old. Of all patients, 20 were with single segmental metastasis, 52 were with multiple segmental metastases, and the main responsible segments were C1-2 5 cases, C3-6 51 cases, C7-T1 16 cases. The course of disease(from the onset of symptoms to the diagnosis of metastatic cancer) was 15d to 4 years. Preoperative Frankel classification: grade A in 7 cases, grade B in 16 cases, grade C in 23 cases, grade D in 23 cases, and grade E in 3 cases. Tumor resection and palliative separation were performed according to the patient′s condition. The surgical efficacy of the patients was evaluated by JOA score and Karnofsi score at preoperation, 2 weeks after operation, and at the last follow-up. Univariate analysis of prognostic factors after surgical treatment of cervical metastasis includedgender, nature of primary tumor, the vertebral segments involved, whether multiple segments were involved or combined with other organic metastases, duration of preoperative neurological symptoms, whether received preoperative radiotherapy and chemotherapy, and methodsof tumor resection. After univariate analysis, factors with statistically significant differences were included in the COX regression model to evaluate the risk factors that affect the prognosis of patients with cervical metastasis. Patients were divided into excellent group(JOA improvement rate ≥50%) and general group(JOA improvement rate <50%) according to the postoperative JOA improvement rate. The factors affecting the efficacy were analyzed: including the duration of preoperative neurological symptoms, whether the tumor had multiple metastases, vertebral segments involved, and SINS score. Results: The operative duration was 50-230min, with an average of 155.85±62.75min, and the intraoperative blood loss was 50-1500ml, with an average of 590.78±556.24ml. All patients had varying degrees of pain relief after surgery. The preoperative JOA score of the cervical spine were 8.44±5.22, 12.35±4.82 after 2 weeks, and 12.96±3.82 at final follow-up, showing significant improvement compared with preoperation(P<0.01). The Karnofsi score before surgery was 52.22±15.08, 66.54±15.21 at 2 weeks postoperatively, and 68.15±12.37 at final follow-up. The Karnofsi scores at 2 weeks postoperatively and at final follow-up were significantly improved compared with preoperatively(P<0.01). The median survival time of 72 patients was 740 days(24.7 months). After univariate analysis, the nature of the primary tumor and whether it was combined with other organic metastases were included as statistically significant factors into the COX regression model analysis. The results showed that "whether it was combined with other organ metastases" affected the prognosis of patients with cervical metastasis as risk factor(P<0.05). In addition, analysis of the results of both groups showed that the duration of preoperative neurological symptoms, preoperative Frankel classification and SINS score had statistically significant effects on the postoperative JOA improvement rate(P<0.05). Conclusions: For patients with cervical spine metastasis, whether combining with other organ metastases is a risk factor affecting their prognoses. Patients with early detection of metastatic lesions, assessment of spine stability, preoperative neurological symptoms lasting less than 72h or with neurological dysfunction in early stage have a better JOA improvement rate. |
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