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脊柱转移癌外科治疗策略及预后因素分析

Surgical management and prognostic factors in patients with spinal metastatic tumors

摘要:

目的 明确脊柱转移癌外科治疗后生存情况、治疗效果及相关预后因素,为制定脊柱转移癌规范化外科治疗方案提供依据.方法 回顾性研究2003年1月至2012年6月接受手术治疗的脊柱转移癌患者资料,对患者因素、肿瘤因素和治疗因素三大类因素与预后的关系进行分析.统计学分析采用Kaplan-Meier法计算生存率,单因素分析、多因素分析均采用Cox回归模型.结果 最终纳入研究453例.其中男性263例,女性190例;年龄10 ~ 86岁,平均(56±13)岁.术后中位生存期为9个月,78例患者(17.2%)发生局部复发,72例患者(15.9%)发生围手术期并发症.单因素分析显示术前一般情况较差(x2=4.16)、术前神经功能严重受损(x2=10.23)、未应用二磷酸盐类药物治疗(x2 =10.47)、转移时间较短(x2=23.31)、以骨转移灶为首发表现(x2=10.94)、原发病灶为快速进展型肿瘤(x2 =15.45)、合并内脏转移(x2 =4.10)、术后未行局部放疗(x2=18.10)和术后未接受敏感的全身治疗(x2=11.20)是影响预后的主要因素(均P<0.05);其中术前神经功能严重受损(P=0.012,95% CI:1.11 ~2.30)、转移时间较短(P=0.023,95%CI:1.05 ~ 1.83)、原发病灶为快速进展型肿瘤(P=0.000,95% CI:1.74 ~ 3.06)、合并内脏转移(P=0.008,95%CI:1.08 ~ 1.68)、术后未行局部放疗(P=0.000,95%CI:1.38 ~2.35)和术后未接受敏感的全身治疗(P=0.045,95% CI:1.01~1.58)为独立预后因素.结论 明确脊柱转移癌患者的预后因素有助于确定手术的适应证,从而进一步提高脊柱转移癌患者的治疗效果和生存期.

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abstracts:

Objective To identify the survival prognostic factors and clinical outcome of the patients with spinal metastatic tumors and to discuss the surgical treatment strategy of spinal metastatic tumors.Methods The patients with spinal metastatic tumors who received surgeries during January 2003 to June 2012 were enrolled.The survival was analyzed by Kaplan-Meier survival curve.The prognostic factors,divided into patient-related factors,tumor-related factors and therapy-related factors,were analyzed univariately and multivariately by Cox comparative hazard model.Results There were 453 patients were enrolled in research including 263 male and 190 female patients with an average age of (56 ± 13) years (10-86 years).The median postoperative survival was 9 months.Local recurrences and peri-operative complications were found in 78 (17.2%) and 72 (15.9%) patients,respectively.Univariate analysis showed the significant prognostic factors for postoperative survival included poor preoperative general condition(x2 =4.16),severe preoperative neurologic deficit(x2 =10.23),not receiving bisphosphonate therapy (x2 =10.47),short disease-free interval before spinal metastasis (x2 =23.31),spinal metastasis as the first manifestation(x2 =10.94),rapid-growth primary tumor(x2 =15.45),visceral metastasis(x2 =4.10),not receiving postoperative radiotherapy(x2 =18.10) and not receiving post-operative sensitive systemic therapy(x2 =11.20) (P <0.05).Multivariate analysis showed the independent prognostic factors include severe preoperative neurologic deficit(P =0.012,95% CI:1.11-2.30),short disease-free interval before spinal metastasis (P =0.023,95% CI:1.05-1.83),rapid-growth primary tumor (P =0.000,95% CI:1.74-3.06),visceral metastasis (P =0.008,95% CI:1.08-1.68),not receiving postoperative radiotherapy (P =0.000,95% CI:1.38-2.35) and not receiving post-operative sensitive systemic therapy (P=0.045,95% CI:1.01-1.58).Conclusion The prognostic factors for survival are useful for determining the indication of operation and improving survival and clinical outcome for patients with spinal metastatic tumors.

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