肺癌脊柱转移瘤的外科治疗疗效及预后因素分析  

Analysis on Surgical Efficacy and Prognostic Factors for Lung Cancer with Spinal Metastasis

作　　者：李玉希[1] 卢世新 梁育玮 李明[1] 程子颖 黄浚燊 黄家俊 黄霖[1] LI Yu-xi;LU Shi-xin;LIANG Yu-wei;LI Ming;CHENG Zi-ying;HUANG Jun-shen;HUANG Jia-jun;HUANG Lin(Department of Orthopedics,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,China)

机构地区：[1]中山大学孙逸仙纪念医院脊柱外科,广东广州510120

出　　处：《中山大学学报（医学科学版）》2021年第6期923-930,共8页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省自然科学基金(2020A1515011388);中山大学孙逸仙纪念医院逸仙科研启航项目(YXQH202009)。

摘　　要：【目的】探讨肺癌脊柱转移瘤患者的手术疗效及影响患者生存期的预后因素。【方法】随访2013年3月至2020年5月于中山大学孙逸仙纪念医院接受诊治的156例肺癌脊柱转移瘤患者,根据纳入与排除标准,36例患者的病例资料入选本研究进行后续分析。根据治疗方式将患者分为手术治疗组(n=26)和保守治疗组(n=10),分别采用视觉疼痛评分(VAS评分)、卡氏日常功能状态评分(KPS评分)及Frankel分级对患者治疗前后的疼痛程度、功能状态和脊髓神经功能进行评估,采用Kaplan-Meier法绘制生存曲线,对影响疾病预后的多种因素采用Cox比例风险模型进行分析。【结果】两组患者治疗前基线特征齐,具有可比性。手术组患者治疗后VAS评分从术前的8.00(3.00~9.00)分下降至术后的2.00(0.75~2.00)分,KPS评分从术前的50.00(40.00~60.00)分上升至术后的60.00(50.00~70.00)分,Frankel分级较术前改善,差异均有统计学意义(P<0.05)。而保守组患者治疗前后的VAS评分、KPS评分及Frankel等级的差异均无统计学意义。36例患者中位生存时间为22.0个月,95%CI为(6.3,37.7)个月,1年生存率68.7%,2年生存率48.0%,3年生存率33.6%。单变量生存分析结果显示性别、吸烟史、病理类型、放化疗和靶向治疗对患者生存期有显著影响。多因素COX比例风险模型生存分析结果显示靶向治疗和放化疗是影响肺癌脊柱转移瘤患者预后的独立因素。【结论】外科手段治疗肺癌脊柱转移瘤能有效缓解患者的疼痛程度、提高生活质量和改善神经功能,靶向治疗和放化疗是影响肺癌脊柱转移瘤患者生存期的重要因素。【Objective】To explore the effect of surgery and prognostic factors on survival in patients with spinal metastasis from lung cancer.【Methods】The clinical and follow-up data of 156 patients with spinal metastasis from lung cancer treated in Sun Yat-sen Memorial Hospital,Sun Yat-sen University from March 2013 to May 2020 were retrospectively analyzed.A total of 36 patients were selected according to the inclusion and exclusion criteria,and were divided into surgical group(n=26)and conservative group(n=10)according to different treatment methods.Visual analog scale score,Karnofsky performance score and Frankel classification were used to evaluate the pain,functional status and spinal cord function of patients before and after treatment.In the end of the study,we drew the Kaplan-Meier survival curve and used Cox proportional hazard model to analyze the factors affecting the prognosis.【Results】The baseline characteristic of patients in the two groups was similar.In the surgical group,the VAS score of patients decreased from 8.00(3.00~9.00)to 2.00(0.75~2.00)after operation.Meanwhile the KPS score of patients increased from 50.00(40.00~60.00)to 60.00(50.00~70.00).And the Frankel classification of patients in surgical group was also improved after operation.The above difference was statistically significant(P<0.05).However,there were no statistically differences in VAS scores,KPS scores and Frankel classification before and after treatment in patients of the conservative group.The median survival time of 36 patients was 22.0 months,95%CI(6.3,37.7)months,with 1-year survival rate 68.7%,2-year survival rate 48.0%and 3-year survival rate 33.6%.The results of univariate survival analysis showed gender,smoking history,pathological type,radiotherapy or chemotherapy,and targeted therapy have a significant impact on patients’survival.The results of multivariate COX proportional hazard model survival analysis suggested radiotherapy or chemotherapy and targeted therapy were independent factors affecting the prognosis.

关 键 词：肺癌 脊柱转移 外科治疗 生存分析 

分 类 号：R737.9[医药卫生—肿瘤]