Comparison Of Curative Effect And Prognosis Analysis Of Patients With Spinal Metastases Treated By Percutaneous Vertebroplasty Combined With Postoperative Radiotherapy And Radiotherapy Alone

Background The spine is one of the most metastatic sites of malignant tumors,second only to the liver and lungs.Spinal metastases are not curable at present.The incidence is high,which can lead to a series of bone related events,significantly reduce the quality of life of patients,and increase the family's economic burden.There are many ways for selection of treatment in patients with metastatic spinal tumor radiotherapy,chemotherapy,drug treatment,open spinal decompression and internal fixation and minimally invasive technique(percutaneous vertebroplasty and percutaneous kyphoplasty)Objective To evaluate the efficacy of percutaneous vertebroplasty combined with postoperative radiotherapy and radiotherapy alone in the treatment of spinal metastatic tumors and to evaluate the prognostic factors for survival.Methods Retrospective analysis was made in the patients with spinal metastases from December 2011 to December 2015 in department of orthopedics and radiotherapy department,PLA 307 Hospital.According to the choice of treatment.Patients in group A(60 cases)were treated with PVP combined with postoperative radiotherapy and those in group B(50 cases)underwent radiotherapy alone,Age,sex,primary tumor type,and other basic characteristics were analyzed in both groups.The pain visual analogue scale,tumors of the spine instability score,physical status score were used to evaluate pain,spinal stability improvement and physical condition.Kaplan-Meier was used to analyze the survival rates of two groups of patients and the influence of primary tumor types on the survival of patients;Cox proportional hazard model was used to calculate the correlations between survival and visceral metastases,system medical treatment,vertebral number before treatment and physical condition.Results There was no significant difference in baseline data between the two groups(P>0.05).The VAS scores were significantly decreased compared with the VAS scores before treatment(P<0.05)in two groups of patients,the KPS scores were significantly increased compared with the KPS scores before treatment(P<0.05).The VAS scores in the group A was significantly lower than the scores in the group B at 1 month,3 months,6 months,and 12 months after surgery.The SINS scores at 1 months and 3 months compared with preoperative in the group A,the difference was statistically significant(P < 0.05),the difference was not statistically significant in the group B(P=0.12).The survival rates of 6 months,1 years,and 3 years were similar between two groups(P>0.05).The influence of different types of primary tumors on the survival time of the patients was statistically significant(P < 0.05).Multiple analysis showed that the internal organs metastasis,systemic medical treatment,the number of vertebral bodies and the physical condition were the important prognostic factors of the survival in patients with spinal metastases.Conclusion PVP combined with postoperative radiotherapy for spinal metastases is better than radiotherapy alone in the treatment of relieving pain,maintaining the stability of vertebral body and improving the quality of life of patients.Survival prognosis was similar in two groups.The types of primary tumors,visceral metastasis,systemic medical treatment,the number of vertebral bodies and the physical condition are important prognostic factors in the survival of patients with spinal metastases.