En Bloc Spondylectomy for Spinal Metastases: Detailed Oncological Outcomes at a Minimum of 2 Years after Surgery

STUDY DESIGN: Retrospective case series. PURPOSE: To investigate the oncological outcomes, including distant relapse, after en bloc spondylectomy (EBS) for spinal metastases in patients with a minimum of 2-year follow-up. OVERVIEW OF LITERATURE: Although EBS has been reported to be locally curative and extend survival in select patients with spinal metastases, detailed reports regarding the control of distant relapse after EBS are lacking. METHODS: We conducted a retrospective review of 18 consecutive patients (median age at EBS, 62 years; range, 40–77 years) who underwent EBS for spinal metastases between 1991 and 2015. The primary cancer sites included the kidney (n=7), thyroid (n=4), liver (n=3), and other locations (n=4). Survival rates were estimated using the Kaplan–Meier method, and groups were compared using the log-rank method. RESULTS: The median operative time and intraoperative blood loss were 767.5 minutes and 2,375 g, respectively. Twelve patients (66.7%) experienced perioperative complications. Five patients (27.8%) experienced local recurrence of the tumor at a median of 12.5 months after EBS, four of which had a positive resection margin status. Thirteen patients (72.2%) experienced distant relapse at a median of 21 months after EBS. The estimated median survival period after distant relapse was 20 months (95% confidence interval, 0.71–39.29 months). No association was found between resection margin status and distant relapse. Overall, the 2-year, 5-year, and 10-year survival rates after EBS were 72.2%, 48.8%, and 27.1%, respectively. Importantly, the era in which EBS was performed did not impact the oncological outcomes. CONCLUSIONS: Our results suggest that EBS by itself, even if margin-free, cannot prevent further dissemination, which occurred in >70% of patients at a median of 21 months after EBS. These results should be considered and conveyed to patients for clinical decision-making.

Allergy and Flavonoid / 日本補完代替医療学会誌

The prevalence of allergic diseases such as asthma, allergic rhinitis and atopic dermatitis has increased all over the world during the last two decades. Dietary change is supposed to be associated with this increase. If it is the case, an appropriate intake of foods or drinks with anti-allergic functions is expected to stop the increase. Flavonoids, ubiquitously present in vegetables, fruits or teas possess anti-allergic activities. Flavonoids inhibit histamine release, synthesis of IL-4 and IL-13 and CD40 ligand expression by basophils and mast cells. Analyses of structure-activity relationships of representative flavones showed that luteolin, apigenin and fisetin were the strongest inhibitors of IL-4 production with an IC₅₀ value of 2–5 μM and determined a fundamental structure for the inhibitory activity. Quercetin and kaempferol showed a substantial activity with an IC₅₀ value of 15–18 μM. The inhibitory activity of flavonoids on IL-4 and CD40 ligand expression were thought to be mediated through their inhibitory action on activation of nuclear factor of activated T cells and AP-1. Administration of flavonoids into atopic dermatitis-prone mice prevented the onset of dermatitis and serum IgE elevation and ameliorated the severity of dermatitis even after the onset. In addition a preliminary trial of flavonoids for adult patients with atopic dermatitis showed a significant effect. Recent epidemiological studies reported that a low incidence of asthma was significantly observed by population with a high intake of flavonoids. Thus, these evidences will be helpful for the development of low molecular compounds for allergic diseases and it is expected that an appropriate daily intake of flavonoids may be an effective complementary and alternative medicine and a preventative strategy for allergic diseases.<br>