脊柱转移瘤患者术后生存期影响因素的多元分析  

Multivariate analysis of factors relating to postoperative survival in patients with spinal metastatic tumors

作　　者：简国坚[1] 谢德胜[1] 叶志扬[1] 刘好源[1] 

机构地区：[1]厦门大学附属成功医院(解放军第174医院)骨一科,福建361000

出　　处：《脊柱外科杂志》2015年第4期228-233,共6页Journal of Spinal Surgery

摘　　要：目的探讨脊柱转移瘤患者术后生存期的影响因素,为临床手术决策提供参考。方法回顾分析2000年1月~2013年1月在本院接受手术治疗且有完整随访资料的98例脊柱转移瘤患者的临床资料,应用Cox比例风险模型分析脊柱转移瘤患者术后生存期的影响因素。结果本组患者术后中位生存期为6.0个月[95%可信区间（credibility interval,CI）：4.9~7.1个月]。甲状腺癌术后生存期最长,为43.0个月（95%CI：0~92.2个月）;结直肠癌最短,为5.0个月（95%CI：1.6~8.4个月）。Cox比例风险模型分析显示,术前Tomita评分≤5分[比值比（odd ratio,OR）=1.439;95%CI：1.003~2.065;P〈0.05]、术后运动功能良好（Frankel分级D、E级;OR=5.397;95%CI：3.560~8.181;P〈0.01）是患者术后生存期独立预测因素;根据术前Tomita评分和术后运动功能状态绘制生存曲线,结果显示术前Tomita评分≤5分或术后运动功能良好的患者生存期显著延长,差异具有统计学意义（P〈0.05）。结论脊柱转移瘤患者制定手术方案时应综合考虑术前Tomita评分和Frankel分级,术前Tomita评分≤5分者或术后Frankel分级D、E级者手术治疗能够获得较好预后;而且术后运动功能较术前身体状态预测效果更好。Object To analyze the factors relating to the survival time of patients with spinal metastatic tumors after operation. Methods The medical records of 98 patients with spinal metastatic tumors who underwent operation from January2000 to January 2013 were retrospectively analyzed. Hematological malignancies,such as multiple myeloma and lymphoma,were excluded. The factors relating to the postoperative survival time were analyzed using Cox regression model. Results The mean age at the time of surgery was 52. 5 years. The median survival time after operation was 6. 0 months [95% credibility interval（ CI） ： 4. 9-7. 1 months]. In univariate analysis,factors such as gender,primary tumor growth rate,preoperative Tomita score,preoperative and postoperative motor function status were shown to be related to postoperative survival time. In multivariate analysis,statistically significant factors were preoperative Tomita score ≤5 points [odd ratio（ OR） = 1. 439; 95%CI： 1. 003-2. 065; P〈0. 05] and postoperative motor function status（ Frankel grade D,E; OR = 5. 397; 95% CI： 3. 560-8. 181; P〈0. 01）. Conclusion The preoperative Tomita score ≤5 points and postoperative motor function status should be considered in the surgery planning of patients with spinal metastatic tumors.

关 键 词：脊椎肿瘤 肿瘤转移 预后 多元分析 

分 类 号：R733.3[医药卫生—肿瘤]