肺癌脊柱转移瘤患者一年生存率的危险因素分析  

Analysis of risk factors for 1-year survival rate in patients with spinal metastasis secondary to lung cancer

作　　者：闫兵山 张净宇 刘艳成[1] 于秀淳 张国川[3] 叶招明[4] 王国文 张余 胡永成[1] Yan Bingshan;Zhang Jingyu;Liu Yancheng;Yu Xiuchun;Zhang Guochuan;Ye Zhaoming;Wang Guowen;Zhang Yu;Hu Yongcheng(Department of Bone and Soft Tissue Oncology,Tianjin hospital,Tianjin 300211,China;Department of Orthopeadics,Chinese people's liberation army 960 hospital,Jinan 250031,China;Department of Bone and Soft Tissue Oncology,Third Hospital of Hebei Medical University,Shijiazhuang 050051,China;Department of Orthopeadics,Second Affiliated Hospital of Zhejiang University,Hangzhou 310009,China;Department of Bone and Soft Tissue Oncology,Tianjin Medical University Cancer Insitute and Hospital,Tianjin 300060,China;Department of Oncology,Guangdong Provincial People's Hospital,Guangzhou 510080,China)

机构地区：[1]天津市天津医院骨与软组织肿瘤科,天津300211 [2]中国人民解放军第九六〇医院,济南250031 [3]河北医科大学第三医院骨肿瘤科,石家庄050051 [4]浙江大学附属第二医院骨科,杭州310009 [5]天津医科大学肿瘤医院骨与软组织肿瘤科,天津300060 [6]广东省人民医院肿瘤科,广州510080

出　　处：《中华骨科杂志》2024年第6期409-418,共10页Chinese Journal of Orthopaedics

摘　　要：目的探讨肺癌脊柱转移患者一年生存率的危险因素。方法回顾性分析2011年1月至2018年12月于天津市天津医院、中国人民解放军第九六〇医院、河北医科大学第三医院、浙江大学附属第二医院、天津医科大学肿瘤医院、广东省人民医院收治的肺癌脊柱转移瘤住院患者343例,男188例、女155例,年龄(59.47±10.21)岁(范围23~91岁)。根据患者是否接受手术治疗分为手术组150例和非手术组193例,记录人口学特征、原发肿瘤类型、非脊柱骨转移情况、内脏转移情况、受累椎体数量、椎体病理性骨折、神经功能Frankel分级、脊柱肿瘤不稳定评分(spinal instability neoplastic score,SINS)、身体功能状态Karnofsky评分(Karnofsky performance scale,KPS)、疼痛视觉模拟评分(visual analogue score,VAS),评估不同治疗方案对肺癌脊柱转移瘤患者生存预后的影响,并通过Cox比例风险回归模型分析影响肺癌脊柱转移瘤患者一年生存率的独立因素。结果46~60岁为高发年龄段(43.7%,150/343),38.5%(132/343)的患者存在受累椎体病理性骨折,58.3%(200/343)的患者合并脊柱外骨转移,36.2%(124/343)的患者合并内脏转移。原发肿瘤中腺癌最为多见(61.5%,211/343),其次为大细胞肺癌(12.5%,43/343)、小细胞肺癌(6.4%,22/343)、鳞癌(6.1%,21/343)和混合细胞肺癌(5.3%,18/343),约8.2%(28/343)的患者肺癌细胞类型不明。150例手术组中微创手术21例(14.0%)、单纯减压手术28例(18.7%)、分离手术76例(50.7%)、根治手术25例(16.6%),59.3%的手术组患者(89/150)神经功能Frankel分级至少改善1级。所有患者平均生存时间9.88个月,中位生存时间8(5,14)个月,6、12、24个月存活率分别为62.1%(213/343)、30.0%(103/343)和3.8%(13/343);手术组平均生存时间10.24个月、中位生存时间9(5,15)个月,非手术组平均生存时间9.41个月、中位生存时间7(5,13)个月,差异无统计学意义(χ2=0.300,P=0.584)。Cox比例风险回归模型分�ObjectiveTo investigate the risk factors for 1-year survival rate in patients with spinal metastasis secondary to lung cancer.MethodsThe data of 343 patients with spinal metastases secondary to lung cancer from January 2011 to December 2018 were retrospectively studied.There were 188 males(54.8%)and 155 females(45.2%)with an average age of 59.47±10.21 years old(range 23-91 years).The patients were divided into operation group(150 cases,43.7%)and non operation group(193 cases,56.3%).The demographics,types of primary tumor,non spinal metastasis,visceral metastasis,spinal metastasis and segments,pathological fractures of vertebra,Frankel classification,physical function status(Karnofsky performance scale,KPS),visual analogue score(VAS),the spinal instability neoplastic score(SINS)were recorded and analyzed.The impact of different treatments on the survival prognosis of patients with spinal metastasis was evaluated.The independent factors affecting survival in those patients were analyzed by Cox proportional hazards regression model.ResultsThe peak incidence of spinal metastases was found in the age group of 46-60 years(43.7%,150/343).38.5%(132/343)of the patients had pathological fractures of the involved vertebral body.58.3%(200/343)of the patients had extraspinal bone metastasis.36.2%(124/343)of the patients had visceral metastasis.Among the primary tumors,adenocarcinoma was the most common tpye(61.5%,211/343),followed by large cell lung cancer(12.5%,43/343),small cell lung cancer(6.4%,22/343),squamous cell cancer(6.1%,21/343)and mixed cell lung cancer(5.3%,18/343).The type of lung cancer cells in about 8.2(28/343)patients was unknown.Among the surgical patients,21 patients underwent minimally invasive surgery(14.0%),28 patients underwent simple decompression surgery(18.7%),76 patients underwent separation surgery(50.7%),and 25 patients underwent radical surgery(16.6%).59.3%(89/150)of the patients had a better neurological function than before surgery.The average survival time of all patients was 9.88 months with

关 键 词：肺癌 脊柱疾病 肿瘤转移 多中心研究 预后 手术治疗 

分 类 号：R734.2[医药卫生—肿瘤] R738.1[医药卫生—临床医学]