一种脊柱转移瘤治疗新策略的回顾性评估  

Retrospective Evaluation of A New Treatment Strategy for Spinal Metastases

作　　者：李浩淼[1] 沈靖南[1] 刘少喻[1] 万勇[1] 梁堂钊[1] Alessandro Gasbarrini Stefano Boriani 

机构地区：[1]中山大学附属第一医院骨-显微医学部,广东广州510080 [2]博洛尼亚Maggiore医院骨创伤与脊柱外科,意大利博洛尼亚40100

出　　处：《中山大学学报（医学科学版）》2010年第6期822-827,共6页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省科技三项经费计划项目(2005B34001002)

摘　　要：【目的】回顾性评估一种新的脊柱转移瘤治疗策略——"流程表"的有效性和不足之处。【方法】研究对象为自1996年2月至2009年1月在我科接受治疗的脊柱转移性肿瘤77例患者,这些患者为生存期明确的死亡病例。对每个病例按照Tomita脊柱转移瘤评分系统和Tokuhashi脊柱转移瘤评分系统(2005年修订版)进行评分,推断其相应的治疗方式,并应用脊柱转移瘤治疗新策略——流程表进行治疗方式判定。将由3种脊柱转移瘤治疗策略所判定的治疗方式与实际治疗方式相比较,分为实际治疗方式与判定治疗方式相一致和不一致两组。再根据流程表策略判定的治疗方式,将病例进一步分成保守治疗、姑息手术和切除手术3组,再将每组中按照实际治疗方式与判定治疗方式一致性分成两小组。然后再应用t检验,一致和不一致两组间进行比较。【结果】按照Tomita脊柱转移瘤评分系统判定治疗和实际治疗的一致组生存时间(11.18个月)虽长于不一致组(9.70个月),但组间无显著差异(P>0.05);按照Tokuhashi脊柱转移瘤评分系统判定治疗和实际治疗的一致组生存时间和不一致组几乎相同(分别为10.18个月和10.31个月,P>0.05);而按脊柱转移瘤流程表策略判定治疗和实际治疗的一致组生存时间(10.62个月)明显长于不一致组(7.70个月,P<0.01)。根据脊柱转移瘤流程表策略判定的治疗方式中,保守治疗和姑息手术组间比较均无显著性差异(P>0.05),而只有清除手术组间比较有显著性差异(P<0.05)。【结论】与评分系统比较,脊柱转移瘤治疗新策略——流程表在改善患者生存时间方面的作用较明显。但该策略仍存在一定不足,如某些评价指标准确性不很高、指标的细化程度不够等,需进一步发展和完善。【Objectives】 To retrospectively evaluate the efficacy of a new treatment strategy-＂flow-chart＂ for spinal metastases and to explore the defects of the algorithm. 【Methods】 This study investigated the 77 patients,who were dead and clear on survival time,treated from February 1996 to January 2009 in our department. Tomita scoring system and Tokuhashi scoring system （edition 2005） as well as flow-chart strategy were respectively applied to these cases to produce different management algorithms. The two subgroups of cases according to each algorithm were divided by comparison between the expected algorithm and the real management approach. Each group according to the different management approaches judged by flow-chart strategy were also divided into two subgroups of cases by comparison between the deduced algorithm and the real management approach. The comparisons between the two subgroups were performed by t-test. 【Results】 The survival time of the cases in the same-treatmentsubgroup （11.18 months） was longer than the cases in the different-treatment subgroup （9.70 months） in the algorithm according to Tomita scoring system,but no significant difference was shown in comparison （P 0.05）; the survival time of the cases in the same-treatment subgroup （10.18 months） was nearly equal to the cases in the different-treatment subgroup （10.31 months） in the algorithm according to Tokuhashi scoring system （P 0.05）; while the survival time of the cases in the same-treatment subgroup （10.62 months） was significantly longer than the cases the different-treatment subgroup （7.70 months） in the algorithm according to the flow-chart strategy （P 0.01）. Among the approaches in the algorithm according to the flow-chart strategy,the comparisons between the two subgroups all showed no significant difference,except for the excisional surgery （P 0.05）. 【Conclusion】 The flow-chart strategy is better than the scoring system in the improvement of survival time. But this new stra

关 键 词：肿瘤 转移 脊柱 治疗 预后 

分 类 号：R738.1[医药卫生—肿瘤]