不同原发肿瘤类型脊柱转移瘤生存预后因素的系统评价与Meta分析  

Prognostic factors for overall survival of patients with spinal metastases from different primary tumor types:a systematic review and meta-analysis

作　　者：相春宇 何小东[1] 郭丰硕 顾锐[1] 柳万国[1] XIANG Chunyu;HE Xiaodong;GUO Fengshuo;GU Rui;LIU Wanguo(China-Japan Union Hospital of Jilin University,Changchun 130033,China)

机构地区：[1]吉林大学中日联谊医院脊柱外科,吉林长春130033

出　　处：《中国实验诊断学》2023年第10期1139-1146,共8页Chinese Journal of Laboratory Diagnosis

基　　金：国家自然科学基金资助课题(82271411);吉林省自然科学基金资助课题(YDZJ202201ZYTS038)

摘　　要：目的明确脊柱转移瘤患者治疗后的预后影响因素。方法系统性地检索PubMed、Embase和CENTRAL数据库中发表于1997年至2018年的脊柱转移瘤预后因素相关文献。以风险比(hazard ration,HR)为效应量对不同原发肿瘤类型相关的预后因素进行meta分析。结果系统评价共纳入44篇文献,病例数为9492例;Meta分析纳入26篇文献,病例数为7072例。共有11个预后因素用于Meta分析,其中内脏转移(HR=1.50,95%CI:1.36~1.66,P<0.001)、术前神经功能(P<0.001)、KPS评分(10~40vs.80~100)(P<0.001)、KPS评分(10~70vs.80~100)(P<0.001)、ECOG评分(P<0.001)、其他骨转移(P<0.001)、脊柱累及数量(≥3VS.1~2)(P<0.001)、脊柱累及数量(>1vs.1)(P=0.027)、原发肿瘤诊断至脊柱转移间期(P<0.001)、运动缺损发展时间(P<0.001)及性别(P=0.011)均对总体生存率有显著影响;而KPS评分(10~40 vs.50~70)(P=0.406)、脊柱转移位置(P=0.436)和年龄(P=0.077)3个预后因素对生存率的影响无统计学意义。结论治疗前神经功能、内脏转移、KPS评分、脊外骨转移、脊柱转移数量、原发肿瘤诊断至脊柱转移间期、运动缺损时间及性别等是脊柱转移瘤患者的独立预后因素。Objective The purpose of this study was to determine the prognostic factors of patients with spinal metastases after treatment.Methods The literature about the prognostic factors of spine metastases published in the PubMed,Embase and CENTRAL databases from 1997 to 2018 was systematically searched.Meta-analysis of prognostic factors associated with different primary tumor types was performed with hazard ration(HR)as the effect size.Results A total of 44 articles were included in the systematic review,involving 9492 patients.The meta-analysis included 26 articles,involving 7072 patients.A total of 11 prognostic factors were used for meta-analysis,among which the visceral metastasis(HR=1.50,95%CI:1.36~1.66,P<0.001),preoperative neurological function(HR=1.97,P<0.001),KPS score(10~40vs.80~100)(HR=2.28,P<0.001),KPS score(10~70vs.80~100)(HR=1.94,P<0.001),ECOG score(HR=1.60,P<0.001),others Bone metastasis(HR=1.34,P<0.001),number of spinal involvement(≥3vs.1~2)(HR=1.48,P<0.001),number of spinal involvement(>1vs.1)(HR=1.45,P=0.027),the primary tumor diagnosis to the spinal metastasis interval(HR=1.22,P<0.001),the developmental time of motor defects(HR=1.58,P<0.001)and gender(HR=1.15,P=0.011)were shown to be significantly associated with overall survival,while KPS score(10~40 vs.50~70)(HR=1.17,P=0.406),spinal metastasis location(HR=1.20,P=0.436)and age(HR=1.01,P=0.077)were not significantly associated with overall survival.Conclusion Pre-treatment neurological function,visceral metastasis,KPS score,extra-osseous bone metastasis,number of spinal metastases,primary tumor diagnosis to spinal metastasis,motor impairment time and gender are independent prognostic factors for patients with spinal metastases.

关 键 词：脊柱转移瘤 总体生存率 预后因素 系统评价 META分析 

分 类 号：R738.2[医药卫生—肿瘤]