Analysis Of Curative Effect And Influencing Factors Of Palliative Surgery For Spinal Metastases

Background and Objective Research background: Spinal metastasis is the most common secondary malignant tumor in spinal surgery,and its incidence accounts for more than 95% of spinal malignancies,which is much higher than other primary spinal tumors.Spinal metastases can easily cause intractable bone pain,collapse of vertebral body fractures and paraplegia,which can seriously reduce the quality of life of patients.A large number of clinical studies have confirmed that: active palliative surgery can significantly improve the quality of life and prolong survival for patients with symptomatic spinal metastases.However,due to the heterogeneity of the primary tumor,the patient’s treatment compliance,and the difference in the location of metastasis,the effect of surgical treatment is significantly different.The current scoring scale(tomita and tokuhashi score)only provides surgery based on the estimated life span,and there is still a lack of scoring and prediction criteria that can predict the efficacy of palliative surgery.Research purpose: This study adopts a retrospective research protocol to collect patients with spinal metastases treated by percutaneous vertebroplasty(PVP)and palliative debulking decompression surgery(Palliative Debulking Decompression Surgery).Correlation analysis of related factors during the operation period,to clarify the related factors that affect the efficacy of surgery,and to provide suggestions for improving the efficacy of clinical surgery in the treatment of spinal metastases.MethodsA retrospective analysis of patients with spinal metastatic tumors admitted to our department from May 2017 to December 2020,a total of 56 eligible patients were collected,including percutaneous vertebroplasty(38 cases)and palliative decompression surgery(18 cases)).The general and clinical data of all patients were collected and followed up by telephone.The content of the follow-up included postoperative treatment measures,pain relief time,and postoperative survival.According to previous research conclusions(Guidelines for the Surgical Treatment of Spinal Metastases,2019,Chinese Journal of Orthopaedics),patients in the PVP group were divided into two groups according to the duration of symptom relief: good efficacy and poor efficacy:(1)More than 3 months is defined as good efficacy,(2)less than 3 months Month is defined as poor efficacy.The following indicators were included as possible influencing factors:(1)Preoperative nutritional status,(2)Activities of daily living,(3)whether low white blood cell,(4)the nature of the primary focus,(5)whether there is a target To drug treatment,(6)whether it is a spinal metastasis that occurred during chemotherapy,(7)whether a radical resection of the primary tumor was performed before the metastasis,(8)the number of vertebral bodies with spinal metastasis,(9)whether there is bone metastasis outside the spine,(10)whether it is accompanied by organ metastasis,(11)whether Postoperative radiotherapy.Carry out single factor and multi-factor logistic regression analysis of the above factors.The patients in the decompression group were divided into two groups with good curative effect and poor curative effect according to the maintenance time of symptom relief:(1)More than 3 months was defined as good curative effect,(2)Less than 3months was defined as poor curative effect.The following indicators were included as possible influencing factors:(1)-(11)same as PVP group,(12)Frankel classification.The single factor and multi-factor logistic regression analysis of the above factors are carried out.Results1.Follow-up and treatment34 of 38 patients who received PVP treatment received complete information follow-up.Among these 34 patients,79%(27/34)had pain relief for more than one month after surgery,and 67%(23/34)had pain relief for more than three months.82%(28/34)of the patients survived more than three months,and 26%(9/34)of the patients survived more than one year.14%(5/34)of the patients received postoperative radiotherapy.All the 18 patients treated with decompression were followed up with complete information.83%(15/18)patients had pain relief for more than one month after surgery,and 72%(13/18)patients had pain relief for more than three months.77%(14/18)of the patients survived more than three months after surgery,and 16%(3/18)of the patients survived more than one year.39%(4/18)of the patients received postoperative radiotherapy.2.Correlation analysis results:Univariate analysis showed that preoperative nutritional status,preoperative life status,targeted drug therapy,spinal metastasis during chemotherapy,extraspinal bone metastasis,visceral metastasis,and postoperative radiotherapy had an impact on the efficacy of surgery(P<0.05).In the decompression group,preoperative nutritional status,preoperative life status,targeted drug treatment,spinal metastasis during chemotherapy,extraspine bone metastasis,visceral metastasis,postoperative radiotherapy,preoperative Frankel graded surgery had an impact(P<0.05).The results of multivariate analysis were:(1)Preoperative malnutrition(P=0.022),poor preoperative living conditions(P=0.035),metastasis during chemotherapy(P=0.043),lack of targeted drugs(P=0.013),refusal of radiotherapy(P=0.015)are independent risks factor for poor efficacy of PVP surgery.(2)Preoperative malnutrition(P=0.032),poor preoperative living conditions(P=0.039),metastasis during chemotherapy(P=0.028),lack of targeted drugs(P=0.021),refusal of radiotherapy(P=0.009),Poor neurological function(P=0.045)are independent risks factor for poor efficacy of palliative decompression surgery.Conclusions1.The overall follow-up results show that regardless of the patient’s preoperative status or postoperative treatment,two palliative surgery methods can make most of the patients directly benefit(PVP surgery(67%,23/34)and palliative decompression surgery(72%,13/18)).2.There is no obvious correlation between the surgical efficacy and the primary focus organs.The control of the primary focus(whether radical resection and chemotherapy are effective)is an important factor affecting the postoperative efficacy.3.Preoperative factors: For PVP: nutritional status and preoperative living conditions are independent related factors that affect the efficacy of surgery.Therefore,positive correction of low protein before surgery is positively helpful to improve the efficacy of surgery;for patients undergoing decompression surgery: Frankel classification is an important predictor of the efficacy of decompression surgery.4.Postoperative factors: Active radiotherapy can improve the therapeutic effect of surgery and prolong the duration of the surgical effect.It is recommended that patients receive stereotactic radiotherapy for metastases after surgery.