颈胸段脊柱转移瘤的手术疗效及生存率  

Surgical efficacy and survival rate of metastatic spinal tumors located on cervicothoracic junction

作　　者：李冬月[1] 刘晓光[2] 刘忠军[2] 姜亮[2] 韦峰[2] LI Dong-yue;LIU Xiao-guang;LIU Zhong-jun;JIANG Liang;WEI Feng(Department of Orthopaedics,Chaoyang Hospital,Capital Medical University,Beijing 100020,China;Department of Orthopaedics,The Third Hospital,Beijing University,Beijing 100191,China)

机构地区：[1]首都医科大学附属北京朝阳医院骨科,北京100020 [2]北京大学第三医院骨科,北京100191

出　　处：《中国矫形外科杂志》2019年第17期1556-1560,共5页Orthopedic Journal of China

摘　　要：[目的]探讨颈胸段脊柱(CTJS)转移瘤的手术疗效、生存情况以及影响转移瘤预后的相关因素。[方法]回顾北京大学第三医院2011年1月~2014年12月收治的CTJS转移瘤患者30例。共采用两种手术方式:12例肿瘤切除术;18例姑息性手术。采用VAS评分、ECOG评分、Frankel分级对疼痛、功能状况和脊髓功能进行评价,采用Kaplan-Meier法评估生存时间。对影响转移瘤预后的多种因素进行COX比例风险模型生存分析。[结果]肿瘤切除组手术时间显著长于姑息性手术组[(317.23±61.87)min vs(190.36±38.31)min,P<0.05];肿瘤切除组术中出血量显著多于姑息性手术组[(1 691.77±411.92)ml vs(1 011.13±223.68)ml,P<0.05]。两组患者术后的VAS评分、ECOG评分均有改善(P<0.05);26例术前脊髓功能障碍者,术后21例(80.77%)Frankel分级获得改善至少一个等级。肿瘤切除组中位生存时间21.00个月,1年生存率66.67%;其中5例原发肿瘤恶性程度中-低度、脊柱孤立性转移的患者术后中位生存期44.00个月。相比之下,姑息性手术组中位生存时间15.50个月,1年生存率55.56%(P<0.05)。多因素COX比例风险模型生存分析结果显示原发肿瘤恶性程度和内脏转移情况影响患者的生存(P<0.05)。[结论]原发肿瘤恶性程度和内脏转移情况影响转移瘤患者的生存。对原发肿瘤恶性程度为中-低度、局部控制好的脊柱孤立性转移瘤行肿瘤切除临床效果满意。[Objective]To investigate surgical efficacy,survival rate and related factor of metastatic spinal tumors located on cervicothoracic junction spine(CTJS).[Methods]From January 2011 to December 2014,a total of 30 patients with CTJS metastatic tumors were surgically treated in the Third Hospital of Beijing University.Two surgical procedures were applied,including tumorectomy in 12 patients and palliative surgery in 18 patients.The visual analogue scale(VAS)for pain,Eastern Cooperative 0 ncology Group scale(ECOG)and Frankel index were used for clinical evaluation.The Kaplan-Meier curve for survival and multivariate Cox proportional hazards models were conducted to search the prognostic factors for CTJS metastatic tumors.[Results]The tumorectomy group consumed significantly longer operation time[(317.23±61.87)min vs(190.36±38.31)min,P<0.05],associated with significantly greater intraoperative blood loss[(1691.77±411.92)ml vs(1011.13±223.68)ml,P<0.05]than the palliative surgery group.After operation the VAS and ECOG scores significantly improved in both groups(P<0.05).In term of neurological function,21 patients(80.77%)of the 26 patients who had neurological deficit preoperatively achieved more than 1 grade improvement in Frankel index after operation.In term of survival,the tumorectomy group proved median survival time of 21.00 months and 1-year survival rate of 66.67%,especially 5 patients of them with solitary metastasis of primary tumors in medium-low malignant level got the median survival time of 44.00 months,whereas the palliative surgery group had median survival time of 15.50 months and 1-year survival rate of 55.56%.The multivariate COX proportional hazards model showed that the malignant level of primary tumors and combined visceral metastases significantly impacted the survival time(P<0.05).[Conclusions]The malignant level of primary tumors and combined visceral metastases have important significances for prognostic assessment of CTJS metastatic tumors.Tumorectomy might achieve satisfactory clinical out

关 键 词：颈胸段脊柱 转移性肿瘤 手术疗效 生存情况 预后因素 

分 类 号：R738.1[医药卫生—肿瘤]