Expanded analysis of vertebral endplate disruption and its impact on vertebral compression fracture risk.

IF 3.3 2区医学 Q2 ONCOLOGY

Radiation Oncology Pub Date : 2025-05-14 DOI:10.1186/s13014-025-02658-z

Khaled Dibs, Prasath Mageswaran, Raju Raval, Evan Thomas, Emile Gogineni, Jeff Pan, Brett Klamer, Ahmet Ayan, Eric Bourekas, Daniel Boulter, Nicholas Fetko, Eric Cochran, Vikram Chakravarthy, John McGregor, Esmerina Tili, Joshua Palmer, Natalie Peters, Russell Lonser, Ahmed Elguindy, Eugene Yap, Soheil Soghrati, William Marras, John Grecula, Arnab Chakravarti, James Elder, Dukagjin Blakaj

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Abstract

Background and objectives: Vertebral compression fracture (VCF) is a potential serious complication of spinal stereotactic body radiotherapy (SBRT). Previously we noted a correlation between advanced Spinal Instability Neoplastic Score (SINS), tumor-related endplate (EP) disruption, and certain primary pathologies with increased VCF risk. Here, we report on an expanded patient cohort to further examine EP disruption's role in VCF.

Methods: This retrospective cohort study was conducted at a single institution, gathering demographic and treatment data from patients who underwent spinal SBRT between 2013 and 2020. EP disruption was identified on pre-SBRT CT scans. Chronic steroid use was defined as steroids administered for 4 weeks or more. The 1-year cumulative incidence of VCF was evaluated by follow-up MRI and CT scans at 3-month intervals post-treatment. Based on multivariate analysis, a nomogram was created using four independent predictors: EP disruption, steroid use, SINS ≥ 7, and adverse histology.

Results: A total of 173 patients were included. The median follow-up was 19 months. Approximately 69 patients (40%) had EP disruption. Thirty patients (17%) experienced a VCF at a median of 4.8 months from SBRT. Patients with adverse histology (HR 2.98, 95% CI [1.42-6.30], p 0.004), steroid use (HR 3.60, 95% CI [1.36-9.51], p 0.01), EP disruption (HR 4.16, 95% CI [1.57-11.05], p 0.004) and a SINS of ≥ 7 (HR 3.63, 95% CI [1.39-9.46], p 0.001) were associated with increased risk of VCF. Based on these findings, a nomogram was created with these four variables stratifying groups at low, intermediate, and high risk of VCF correlating with rates of 2%, 21% and 58% risk (P <.001).

Conclusion: In this expanded pooled analysis, consistent with previously published findings, EP disruption, adverse pathology, and higher SINS scores were associated with an increased risk of VCF. Additionally, we found that chronic steroid use for four weeks or greater also correlated with a higher risk of VCF.

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椎体终板断裂及其对椎体压缩性骨折风险影响的扩展分析。

背景和目的：椎体压缩性骨折（VCF）是脊柱立体定向放射治疗（SBRT）的潜在严重并发症。先前我们注意到晚期脊柱不稳定肿瘤评分（SINS）、肿瘤相关终板（EP）破坏和某些原发性病理与VCF风险增加之间的相关性。在这里，我们报告了一个扩大的患者队列，以进一步研究EP中断在VCF中的作用。方法：本回顾性队列研究在单一机构进行，收集2013年至2020年间接受脊柱SBRT患者的人口统计学和治疗数据。在sbrt前的CT扫描中发现了脑电图中断。慢性类固醇使用被定义为使用类固醇4周或更长时间。治疗后每隔3个月通过随访MRI和CT扫描评估1年VCF累积发生率。基于多变量分析，使用四个独立的预测因素：EP破坏、类固醇使用、SINS≥7和不良组织学，创建了一个nomogram。结果：共纳入173例患者。中位随访时间为19个月。约69例患者（40%）出现EP中断。30例患者（17%）在SBRT后4.8个月发生VCF。组织学不良（HR 2.98, 95% CI [1.42-6.30], p 0.004）、类固醇使用（HR 3.60, 95% CI [1.36-9.51], p 0.01）、EP中断（HR 4.16, 95% CI [1.57-11.05], p 0.004）和SINS≥7 （HR 3.63, 95% CI [1.39-9.46], p 0.001）的患者与VCF风险增加相关。基于这些发现，我们创建了一个由这四个变量组成的nomogram，将VCF的低、中、高风险（分别为2%、21%和58%）分组。结论：在这个扩展的汇总分析中，与之前发表的研究结果一致，EP中断、不良病理和较高的SINS评分与VCF的风险增加相关。此外，我们发现慢性类固醇使用四周或更长时间也与VCF的高风险相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Radiation Oncology ONCOLOGY-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

CiteScore

6.50

自引率

2.80%

发文量

181

审稿时长

3-6 weeks

期刊介绍： Radiation Oncology encompasses all aspects of research that impacts on the treatment of cancer using radiation. It publishes findings in molecular and cellular radiation biology, radiation physics, radiation technology, and clinical oncology.