肿瘤消融技术在脊柱转移瘤中的应用现状

Application status of tumor ablation technique in patients with spinal metastases

中文关键词:  消融技术  脊柱转移瘤  有效性  安全性  系统评价

英文关键词:Ablation technique  Spinal metastases  Effectiveness  Safety  Systematic review

中文摘要:

  【摘要】 目的：对消融技术治疗脊柱转移瘤有效性与安全性的临床证据进行系统评价。方法：根据PRISMA声明，系统检索PubMed、Embase以及Cochrane数据库2013年1月～2023年4月期间正式发表的关于消融技术治疗脊柱转移瘤的相关文献。两位研究者按纳入与排除标准独立筛选文献，提取数据。主要的结局指标包括脊柱转移瘤消融技术治疗后患者的疼痛缓解、生活质量改善、局部肿瘤控制率以及并发症发生情况。结果：最终共纳入40篇研究，包括1943例患者，其中25篇研究评估了射频消融在脊柱转移瘤中的应用，微波消融与冷冻消融分别为9篇和6篇。纳入研究的治疗方式主要为消融与椎体增强术的联合治疗。脊柱转移瘤患者在接受联合治疗后1周和1、3、6个月的视觉模拟评估法（visual analogue scale，VAS）疼痛评分以及Oswestry功能障碍指数（Oswestry disability index，ODI）评分均较术前基线标准有显著下降，治疗后的患者在随访期内有良好的局部肿瘤控制以及较低的并发症发生率。结论：消融技术治疗脊柱转移瘤是安全有效的，与椎体骨水泥增强术联合治疗能进一步提高疗效，有望在脊柱转移瘤的治疗中得到进一步应用。

英文摘要:

  【Abstract】 Objectives: To systematically evaluate the clinical evidence of the effectiveness and safety of tumor ablation technique in treating spinal metastasis. Methods: According to the PRISMA statement, a comprehensive retrieval of the literatures related to tumor ablation for spinal metastases published between January 2013 and April 2023 in PubMed, Embase, and Cochrane database was conducted. Two reviewers independently screened eligible articles in accordance with the inclusion and exclusion criteria, and extracted data. The primary outcomes were pain relief, improvement in quality of life, local tumor control rate, and complications after ablation of spinal metastases. Results: A total of 40 articles involving 1943 patients were included, and among which 25 articles assessed the radiofrequency ablation, 9 evaluated microwave ablation and 6 was about cryoablation, respectively. The pattern of treatments was mainly combination of ablation and vertebral augmentation. After the combination treatment of patients with spinal metastases in 1 week and 1, 3, 6 months, the visual analogue scale(VAS) pain score and Oswestry disability index(ODI) were significantly decreased compared with baseline status. A good local tumor control and lower incidence of complications were also shown during follow-up period. Conclusions: Tumor ablation technique for treating spinal metastases is safe and effective, which is more effective when combining with bone cement vertebral augmentation, and is expected to become the standard treatment of spinal metastases.