脊柱转移肿瘤治疗决策系统的研究进展  

Advances in decision-making system for the treatment of spinal metastatic tumors

作　　者：钟远鸣[1] 赵庆瑞(综述) 叶伟权 邱伟(审校) ZHONG Yuanming;ZHAO Qingrui;YE Weiquan;QIU Wei(the First Affiliated Hospital of Guangxi University,Nanning,Guangxi 530001,China;School of Graduate Studies,Guangxi University of Chinese Medicine,Nanning,Guangxi 530001,China)

机构地区：[1]广西中医药大学第一附属医院,南宁530001 [2]广西中医药大学研究生院,南宁530001

出　　处：《重庆医学》2022年第5期884-889,共6页Chongqing medicine

基　　金：国家自然科学基金项目(81760874);广西壮族自治区重点研发计划(桂科AB20159018);广西中医药大学2021年研究生教育创新计划项目(YCXJ2021048)。

摘　　要：骨骼是晚期恶性肿瘤常见的侵犯部位,其中脊柱转移肿瘤由于其独特的解剖位置,往往容易压迫脊髓、神经等组织而产生严重的并发症。既往主要依据Tokuhashi、Tomita等经典预后评分系统对脊柱转移瘤患者进行预后评估,但上述系统未能从靶向治疗及其他一些新兴的治疗方式中获益,准确性逐渐降低。近年来立体定向放射外科手术(SRS)、微创外科技术(MIS)及生物治疗等不断发展,脊柱转移瘤患者的预后情况进一步改善,Bartels、Bollen、Lei等现代预后评分系统应运而生,它们的出现提高了预后评估有效性,但仅依靠预期生存时间仍不能直接进行临床决策。NOMS及其他基于治疗原则的决策系统综合考虑了患者肿瘤学、脊柱稳定性、全身系统情况等多个方面制订治疗方案,应用广泛。该文简要综述脊柱转移性肿瘤评分决策系统的发展历史及研究进展,讨论其优缺点并对未来制订新型决策系统提出建议。Bone is a common invasion site of advanced malignant tumors.Because of its unique anatomical position,the spinal metastatic tumors are often easy to oppress the spinal cord,nerves and other tissues and produce serious complications.In the past,Tokuhashi,Tomita and other classical scoring systems were mainly used to evaluate the prognosis of the patients with spinal metastatic tumors.But they failed to benefit from some emerging treatment methods,and their accuracy gradually decreased.In recent years,with the continuous development of minimally invasive surgery(MIS),stereotactic radiosurgery(SRS)and biotherapy,the prognosis of the patients with spinal metastases has been further improved.Modern scoring systems such as Bartels,Bollen and Lei emerge as the times require,which have improved the effectiveness of the prognosis evaluation.However,the expected survival time alone is still not a direct basis for clinical decision-making.NOMS and other decision systems based on treatment principles comprehensively consider multiple aspects such as patients′oncology,spinal stability and systemic conditions to formulate treatment plans,which are widely used.This paper briefly reviews the development history and research progress of the scoring decision system for spinal metastatic tumors,discusses their advantages and disadvantages,and puts forward some suggestions for the development of a new decision system in the future.

关 键 词：脊柱转移肿瘤 预后评估 决策系统 放射治疗 手术治疗 综述 

分 类 号：R738.1[医药卫生—肿瘤]