Introduction

Spinal metastasis is the most common metastatic skeletal disease in cancer patients. Metastatic epidural spinal cord compression (MESCC), which occurs in 5–14% of cancer patients, is an oncological emergency because it may cause a permanent neurological deficit. Separation surgery followed by stereotactic ablative radiotherapy (SABR), so-called “hybrid therapy,” has shown effectiveness in local control of spinal metastasis and has become an integral treatment option for patients with MESCC. Therefore, we performed a meta-analysis and meta-regression analysis to clarify the local progression rate of hybrid therapy and the risk factors for local progression.

Methods

We searched PubMed, EMBASE, Scopus, Cochrane Library, and Web of Science databases from inception to December 2021. Meta-analyses of proportions were used to analyze the data using a random-effects model to calculate the pooled 1-year local progression rate and confidence interval. Subgroup analyses were performed using meta-analyses of odds ratio (OR) for comparisons between groups. We also conducted a meta-regression analysis to identify the factors that caused heterogeneity.

Results

A total of 661 patients from 13 studies (10 retrospective and 3 prospective) were included in the final meta-analysis. The quality of the included studies assessed using the Newcastle − Ottawa scale ranged from poor to fair (range, 4–6). The pooled local progression rate was 10.2 % (95 % confidence interval [CI], 7.8–12.8 %; I² = 30 %) and 13.7 % (95 % CI, 9.3–18.8 %; I² = 55 %) at postoperative 1 and 2 years, respectively. The subgroup analysis indicated that patients with a history of prior radiotherapy (OR, 5.14; 95 % CI, 1.71–15.51) and lower radiation dose per fraction (OR, 4.57; 95 % CI, 1.88–11.13) showed significantly higher pooled 1-year local progression rates. In the moderator analysis, the 1-year local progression rate was significantly associated with the proportion of patients with a history of prior radiotherapy (p = 0.036) and those with colorectal cancer as primary origin (p < 0.001).

Conclusions

The pooled 1-year local progression rate of hybrid therapy for MESCC was 10.2%. In subgroup and moderator analyses, a lower radiation dose per fraction, history of prior radiotherapy, and colorectal cancer showed a significant association with the 1-year local progression rate.

中文翻译：

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分离手术后立体定向消融放射治疗转移性硬膜外脊髓压迫：局部进展率的系统评价和荟萃分析

介绍

脊柱转移是癌症患者中最常见的转移性骨骼疾病。转移性硬膜外脊髓压迫症 (MESCC) 发生在 5-14% 的癌症患者中，是一种肿瘤急症，因为它可能导致永久性神经功能缺损。分离手术后进行立体定向消融放疗 (SABR)，即所谓的“混合疗法”，已显示出局部控制脊柱转移的有效性，并已成为 MESCC 患者不可或缺的治疗选择。因此，我们进行了荟萃分析和荟萃回归分析，以阐明混合疗法的局部进展率和局部进展的危险因素。

方法

我们搜索了从开始到 2021 年 12 月的 PubMed、EMBASE、Scopus、Cochrane Library 和 Web of Science 数据库。使用比例的元分析来分析数据，使用随机效应模型计算汇总的 1 年局部进展率和置信区间。使用比值比 (OR) 的荟萃分析进行亚组分析以进行组间比较。我们还进行了元回归分析以确定导致异质性的因素。

结果

来自 13 项研究（10 项回顾性和 3 项前瞻性）的总共 661 名患者被纳入最终的荟萃分析。使用纽卡斯尔 - 渥太华量表评估的纳入研究的质量从差到一般（范围，4-6）。汇总的局部进展率为 10.2%（95% 置信区间 [CI]，7.8–12.8%；I ²  = 30%）和 13.7%（95% CI，9.3–18.8%；I ² = 55 %，分别在术后 1 年和 2 年。亚组分析表明，既往放疗史（OR，5.14；95% CI，1.71-15.51）和每次放疗剂量较低（OR，4.57；95% CI，1.88-11.13）的患者显示出显着更高的合并 1-年本地进展率。在调节分析中，1 年局部进展率与既往放疗史 (p = 0.036) 和以结直肠癌为原发灶的患者比例 (p < 0.001) 显着相关。

结论

MESCC 混合疗法的合并 1 年局部进展率为 10.2%。在亚组和调节分析中，较低的每次放疗剂量、既往放疗史和结直肠癌与 1 年局部进展率显着相关。