一例晚期肺癌脊柱轉移患者的循證治療_《中國循證醫學雜志》

作者：

李娟 ¹ ,  石銳 ² , 余萍 ¹

1. 四川省腫瘤醫院肺部腫瘤病區（成都 610041）；2. 四川大學華西醫院骨科（成都 610041）;

關鍵詞：

肺癌脊柱轉移循證治療

DOI：

10.7507/1672-2531.20130136

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目的　針對一例晚期肺癌脊柱轉移患者病情和治療預期，結合最新的循證醫學證據，制定治療決策。
方法　按照PICO原則，對患者在治療中面臨的問題進行轉換并制定檢索策略后，在多個數據庫中進行文獻檢索。按照循證醫學5級證據分級標準，選擇最佳的臨床證據進行解讀，并指導治療決策。
結果　檢出相關文獻148篇，最終納入4篇系統評價/Meta 分析。針對患者關心的4個方面的問題均獲得1級證據支持，包括恢復脊髓功能（行走和括約肌功能）、局部疼痛控制、遠期生存率和治療并發癥。根據患者意愿，最終選擇了治療后并發癥相對高發，但能夠更好恢復神經功能，顯著緩解疼痛，提高遠期生存率的手術減壓治療。術后患者行走功能完全恢復。
結論　采用循證治療方法，能為肺癌脊柱轉移伴脊髓壓迫患者選擇合理的治療方案。對于惡性脊髓壓迫患者，如出現行走功能障礙，且具備手術條件，應盡早進行減壓手術，以盡早恢復脊髓功能，緩解疼痛，提高遠期生存率。但醫患雙方均應對手術治療存在較高的并發癥風險有充分的共識和諒解。

引用本文： 李娟,石銳,余萍. 一例晚期肺癌脊柱轉移患者的循證治療. 中國循證醫學雜志, 2013, 13(6): 768-772. doi: 10.7507/1672-2531.20130136 復制

1.	Smith RA, Brooks D, Cokkinides V, et al. Cancer screening in the United States, 2013: A review of current american cancer society guidelines, current issues in cancer screening, and new guidance on cervical cancer screening and lung cancer screening. CA Cancer J Clin, 2013, doi: 10.3322/caac.21174.
2.	Marshall HM, Leong SC, Bowman RV, et al. The science behind the 7th edition Tumour, Node, Metastasis staging system for lung cancer. Respirology, 2012, 17(2): 247-260.
3.	Sun H, Nemecek AN. Optimal management of malignant epidural spinal cord compression. Hematol Oncol Clin North Am, 2010, 24(3): 537-551.
4.	Abrahm JL, Banffy MB, Harris MB. Spinal cord compression in patients with advanced metastatic cancer: "all I care about is walking and living my life". JAMA, 2008, 299(8): 937-946.
5.	吳娟, 鄭偉, 吳志鵬. 手術對脊柱轉移性腫瘤患者晚期生命質量的影響. 中國循證醫學雜志, 2012, 12(9): 1041-1046.
6.	National Collaborating Centre for Cancer. Metastatic spinal cord compression. Diagnosis and management of adults at risk of and with metastatic spinal cord compression. London (UK): National Institute for Health and Clinical Excellence (NICE); 2008 Nov. 39 p. (Clinical guideline; no. 75).
7.	Loblaw DA, Mitera G, Ford M, et al. A 2011 Updated Systematic Review and Clinical Practice Guideline for the Management of Malignant Extradural Spinal Cord Compression. Int J Radiat Oncol Biol Phys, 2012, 84(2): 312-317.
8.	Kim JM, Losina E, Bono CM, et al. Clinical outcome of metastatic spinal cord compression treated with surgical excision +/- radiation versus radiation therapy alone: a systematic review of literature. Spine (Phila Pa 1976), 2012, 37(1): 78-84.
9.	George R, Jeba J, Ramkumar G, et al. Interventions for the treatment of metastatic extradural spinal cord compression in adults. Cochrane Database Syst Rev, 2008, 8(4): CD006716.
10.	Klimo PJr, Thompson CJ, Kestle JR, et al. A meta-analysis of surgery versus conventional radiotherapy for the treatment of metastatic spinal epidural disease. Neuro Oncol, 2005, 7(1): 64-76.
11.	Helweg-Larsen S. Clinical outcome in metastatic spinal cord compression. A prospective study of 153 patients. Acta Neurol Scand, 1996, 94(4): 269-275.
12.	King GJ, Kostuik JP, McBroom RJ, et al. Surgical management of metastatic renal carcinoma of the spine. Spine (Phila Pa 1976), 1991, 16(3): 265-271.
13.	Maranzano E, Latini P. Effectiveness of radiation therapy without surgery in metastatic spinal cord compression: final results from a prospective trial. Int J Radiat Oncol Biol Phys, 1995, 32(4): 959-967.
14.	Overby MC, Rothman AS. Anterolateral decompression for metastatic epidural spinal cord tumors. Results of a modified costotransversectomy approach. J Neurosurg, 1985, 62(3): 344-348.
15.	Siegal T, Siegal T. Surgical decompression of anterior and posterior malignant epidural tumors compressing the spinal cord: a prospective study. Neurosurgery, 1985, 17(3): 424-432.
16.	Hirabayashi H, Ebara S, Kinoshita T, et al. Clinical outcome and survival after palliative surgery for spinal metastases: palliative surgery in spinal metastases. Cancer, 2003, 97(2): 476-484.
17.	Fourney DR, Abi-Said D, Lang FF, et al. Use of pedicle screw fixation in the management of malignant spinal disease: experience in 100 consecutive procedures. J Neurosurg, 2001, 94(1 Suppl): 25-37.
18.	Weigel B, Maghsudi M, Neumann C, et al. Surgical management of symptomatic spinal metastases. Postoperative outcome and quality of life. Spine (Phila Pa 1976), 1999, 24(21): 2240-2246.
19.	Kovner F, Spigel S, Rider I, et al. Radiation therapy of metastatic spinal cord compression. Multidisciplinary team diagnosis and treatment. J Neurooncol, 1999, 42(1): 85-92.
20.	Patchell RA, Tibbs PA, Regine WF, et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet, 2005, 366(9486): 643-648.
21.	Guyatt GH. Evidence-based medicine. ACP J Club, 1991, 114(S2): A16.

1. Smith RA, Brooks D, Cokkinides V, et al. Cancer screening in the United States, 2013: A review of current american cancer society guidelines, current issues in cancer screening, and new guidance on cervical cancer screening and lung cancer screening. CA Cancer J Clin, 2013, doi: 10.3322/caac.21174.
2. Marshall HM, Leong SC, Bowman RV, et al. The science behind the 7th edition Tumour, Node, Metastasis staging system for lung cancer. Respirology, 2012, 17(2): 247-260.
3. Sun H, Nemecek AN. Optimal management of malignant epidural spinal cord compression. Hematol Oncol Clin North Am, 2010, 24(3): 537-551.
4. Abrahm JL, Banffy MB, Harris MB. Spinal cord compression in patients with advanced metastatic cancer: "all I care about is walking and living my life". JAMA, 2008, 299(8): 937-946.
5. 吳娟, 鄭偉, 吳志鵬. 手術對脊柱轉移性腫瘤患者晚期生命質量的影響. 中國循證醫學雜志, 2012, 12(9): 1041-1046.
6. National Collaborating Centre for Cancer. Metastatic spinal cord compression. Diagnosis and management of adults at risk of and with metastatic spinal cord compression. London (UK): National Institute for Health and Clinical Excellence (NICE); 2008 Nov. 39 p. (Clinical guideline; no. 75).
7. Loblaw DA, Mitera G, Ford M, et al. A 2011 Updated Systematic Review and Clinical Practice Guideline for the Management of Malignant Extradural Spinal Cord Compression. Int J Radiat Oncol Biol Phys, 2012, 84(2): 312-317.
8. Kim JM, Losina E, Bono CM, et al. Clinical outcome of metastatic spinal cord compression treated with surgical excision +/- radiation versus radiation therapy alone: a systematic review of literature. Spine (Phila Pa 1976), 2012, 37(1): 78-84.
9. George R, Jeba J, Ramkumar G, et al. Interventions for the treatment of metastatic extradural spinal cord compression in adults. Cochrane Database Syst Rev, 2008, 8(4): CD006716.
10. Klimo PJr, Thompson CJ, Kestle JR, et al. A meta-analysis of surgery versus conventional radiotherapy for the treatment of metastatic spinal epidural disease. Neuro Oncol, 2005, 7(1): 64-76.
11. Helweg-Larsen S. Clinical outcome in metastatic spinal cord compression. A prospective study of 153 patients. Acta Neurol Scand, 1996, 94(4): 269-275.
12. King GJ, Kostuik JP, McBroom RJ, et al. Surgical management of metastatic renal carcinoma of the spine. Spine (Phila Pa 1976), 1991, 16(3): 265-271.
13. Maranzano E, Latini P. Effectiveness of radiation therapy without surgery in metastatic spinal cord compression: final results from a prospective trial. Int J Radiat Oncol Biol Phys, 1995, 32(4): 959-967.
14. Overby MC, Rothman AS. Anterolateral decompression for metastatic epidural spinal cord tumors. Results of a modified costotransversectomy approach. J Neurosurg, 1985, 62(3): 344-348.
15. Siegal T, Siegal T. Surgical decompression of anterior and posterior malignant epidural tumors compressing the spinal cord: a prospective study. Neurosurgery, 1985, 17(3): 424-432.
16. Hirabayashi H, Ebara S, Kinoshita T, et al. Clinical outcome and survival after palliative surgery for spinal metastases: palliative surgery in spinal metastases. Cancer, 2003, 97(2): 476-484.
17. Fourney DR, Abi-Said D, Lang FF, et al. Use of pedicle screw fixation in the management of malignant spinal disease: experience in 100 consecutive procedures. J Neurosurg, 2001, 94(1 Suppl): 25-37.
18. Weigel B, Maghsudi M, Neumann C, et al. Surgical management of symptomatic spinal metastases. Postoperative outcome and quality of life. Spine (Phila Pa 1976), 1999, 24(21): 2240-2246.
19. Kovner F, Spigel S, Rider I, et al. Radiation therapy of metastatic spinal cord compression. Multidisciplinary team diagnosis and treatment. J Neurooncol, 1999, 42(1): 85-92.
20. Patchell RA, Tibbs PA, Regine WF, et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet, 2005, 366(9486): 643-648.
21. Guyatt GH. Evidence-based medicine. ACP J Club, 1991, 114(S2): A16.

《中國循證醫學雜志》

一例晚期肺癌脊柱轉移患者的循證治療

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《中國循證醫學雜志》

一例晚期肺癌脊柱轉移患者的循證治療

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