肺癌脊柱转移手术治疗和放射治疗的临床分析  

Therapeutic effect of surgery compared with radiotherapy in spinal metastases from lung cancer

作　　者：王国文[1] 韩秀鑫[1] 张超[1] 马育林[1] 多健[1] 杨吉龙[1] 廖志超[1] 

机构地区：[1]天津医科大学附属肿瘤医院骨与软组织肿瘤科天津市肿瘤防治重点实验室,300060

出　　处：《中国矫形外科杂志》2013年第5期425-429,共5页Orthopedic Journal of China

摘　　要：[目的]对比分析肺癌脊柱转移患者手术治疗和放射治疗的临床疗效。[方法]回顾性分析2004年6月～2010年12月肺癌脊柱转移患者24例。男14例,女10例;年龄40～65岁,平均53.4岁。放射治疗组15例,其中4例联合化疗、2例联合靶向治疗;手术治疗组9例,均为开放手术且应用脊柱内固定,其中2例患者联合化疗、3例联合靶向治疗,治疗后对患者进行随访并进行生存分析,术前、术后1个月及术后3个月应用视觉模拟评分(visualanalogue scale,VAS)评估疼痛,术前、术后3个月分别应用Frankel分级对脊髓损伤进行评估,应用卡式(Karnofsky,KPS)评分系统对功能状态进行评分。[结果]随访2～16个月,平均随访8.3个月。放疗组平均生存时间7.7个月,中位生存时间为7.0个月;手术治疗组平均生存时间为9.3个月,中位生存时间为8.4个月,手术治疗组生存时间较放疗组无统计学差异(P>0.05);对治疗前、后1、3个月疼痛VAS评分进行统计学分析,手术治疗组和放疗组治疗后疼痛缓解程度较治疗前均具有统计学意义,并且手术治疗组治疗后1、3个月疼痛缓解程度均优于放疗组,具有统计学意义(P<0.01);手术治疗组术后3个月Frankel分级D、E级比例由术前的77.8%提高到88.9%,放疗组由治疗前的66.7%提高到73.3%;手术治疗组KPS评分80～100分比例较治疗前提高22.2%,放疗组提高13.3%。手术治疗组脊髓损伤和功能状态缓解程度均优于放疗组。[结论]肺癌脊柱转移患者采取手术治疗与放射治疗相比,能够延长生存时间,但无统计学差异,同时应用手术治疗后能够明显减轻疼痛、改善功能、提高生存质量。[ Objective ] To compare the therapeutic efficacy between surgery and radiotherapy in spinal metastases from lung cancer. [ Methods] A retrospective analysis of clinical data from June 2004 to December 2010 was performed in 24 pa- tients with spinal metastases of lung cancer. Patients were from 40 to 65 years , 14 males and 10 females, with mean age of 53.4 years. Fifteen of the 24 patients received radiotherapy, 4 patients combined chemotherapy and 2 patients combined targeted ther- apy. Nine patients received surgery, 2 patients combined chemotherapy, 5 patients combined targeted therapy. Follow - up and survival time was analyzed. Pain levels were assessed by visual analogue scale （VAS） in pre -treatment, post -treatment 1 and 3 month. Neurologic deficit was evaluated by Frankel Grade and functional impairment was classified by Karnofsky Score. [ Re- suits] The period of follow -up ranged from 2 to 16 months with the average of 8.3 months. In radiotherapy group, the mean survival was 7.7 months and the median survival was 7. 0 months. In surgery group, the mean survival was 9. 3 months and the median survival was 8.4 months. The difference of survival times between the two groups was not statistically significant （ P 〉 0. 05） . In pre - treatment, post - treatment 1 and 3 month, the VAS in both groups showed statistical significance at each time point. Post - operatively, 88. 9% of all patients had functionally useful Frankel Grade D or E compared with 77.8% pre - oper- atively. The radiotherapy group was 73.3% post - treatment compared with 66. 7% pre - treatment. KPS score （80 - 100） per- centage in surgery group and in radiotherapy group was increased by 22.2% and 13.3%, respectively. The relief of spinal cord injury and functional status in surgical group was superior to radiotherapy group. [ Conclusion ] Compared with radiotherapy,surgery can prolong the survival time, but with no statistically significant. Surgery can also improve pain, function and quality of patients with spinal metastase

关 键 词：肺癌  脊柱转移瘤  放疗  手术治疗 

分 类 号：R738.1[医药卫生—肿瘤]