中国癌症杂志2026，Vol.36Issue(5)：479-487,9.DOI:10.19401/j.cnki.1007-3639.2026.05.006
黑色素瘤脊柱转移患者手术预后因素分析:一项回顾性队列研究
Analysis of prognostic factors for surgery in patients with spinal metastasis from melanoma:a retrospective cohort study
摘要
Abstract
Background and purpose:Melanoma is a highly malignant tumor with a relatively low incidence rate but a high fatality rate.When melanoma metastasizes to the spine,it exhibits strong aggressiveness,often invading the vertebral body and forming soft tissue masses.As the tumor progresses,it further compresses the nerve roots and spinal cord,causing severe pain in patients,which can lead to paralysis in severe cases.Therefore,surgical intervention is required for patients with spinal metastasis of melanoma as soon as possible.This study aimed to explore surgical treatment and prognostic factors for patients with spinal metastasis from melanoma.Methods:Clinical and follow-up data of 58 patients with melanoma spinal metastases admitted to the Affiliated Tumor Hospital of Xinjiang Medical University from 2008 to 2024 were collected.Inclusion criteria:① Patients with confirmed melanoma who have undergone spinal surgery and have been pathologically diagnosed with metastasis;② Estimated survival time greater than 3 months;③ Have already experienced or are about to experience spinal instability and/or spinal cord compression.Exclusion criteria:① Patients with other malignant tumors;② Patients who cannot tolerate surgery upon evaluation;③ Patients with incomplete follow-up data;④ Patients with brain metastasis.This study was approved by the ethics committee of the Affiliated Tumor Hospital of Xinjiang Medical University(ethics approval number:S-2024167),and exempted from obtaining informed consent from patients.According to the stratification of treatment periods,the differences in treatment strategies at different stages were analyzed,and the treatment period was included as a covariate in the multivariate model.Before and after surgery,patients were evaluated using the visual analogue scale(VAS)for pain,Frankel classification for spinal cord injury,and the Eastern Cooperative Oncology Group(ECOG)score.The Kaplan-Meier method was used for survival analysis,the log-rank test was used for intergroup survival rate comparison,and Cox regression analysis was used to identify the influencing factors of patient prognosis.Results:The median overall survival(OS)for 58 patients with melanoma spinal metastases was 11 months.The average surgical duration was 273 minutes,with an average blood loss of 1 407 mL.Compared to preoperative levels,postoperative patients exhibited significantly reduced VAS and ECOG scores,along with a notable improvement in Frankel grading(all P＜0.05).Univariate analysis revealed that the ECOG score,preoperative Frankel grading,interval from melanoma diagnosis to spinal metastasis,presence of non-spinal metastases,receipt of postoperative systemic therapy,and type of postoperative systemic therapy were all significantly correlated with OS in melanoma patients with spinal metastasis(all P＜0.05).After adjusting for the treatment era,multivariate Cox regression analysis showed that preoperative Frankel grading[hazard ratio(HR)=0.173,95%CI:0.043-0.700],non-spinal metastases(HR=4.131,95%CI:1.863-9.159)and postoperative systemic therapy(HR=0.048,95%CI:0.009-0.250)were independent factors affecting OS in patients with melanoma spinal metastases.Conclusion:Surgical treatment can significantly alleviate the pain of patients with melanoma spinal metastases and improve their quality of life.Preoperative Frankel grading,metastasis outside the spine,and whether postoperative systemic therapy is received are independent factors affecting the OS of melanoma patients with spinal metastases.关键词
黑色素瘤/脊柱转移瘤/手术治疗/预后/观察性研究Key words
Melanoma/Spinal metastases/Surgical treatment/Prognosis/Observational study分类
医药卫生引用本文复制引用
温苗,张晶,王贵芬,赵晓琴,王新艳,麦尔旦江·麦合木提,杜俊炜..黑色素瘤脊柱转移患者手术预后因素分析:一项回顾性队列研究[J].中国癌症杂志,2026,36(5):479-487,9.基金项目
新疆维吾尔自治区卫生健康科研项目(2025001QNKYXM650027539) （2025001QNKYXM650027539）
新疆维吾尔自治区自然科学基金资助项目(2022D01C803). Research Project of Xinjiang Uygur Autonomous Region Health Commission(2025001QNKYXM650027539) （2022D01C803）
Natural Science Foundation of Xinjiang Uygur Autonomous Region(2022D01C803). （2022D01C803）
