文章摘要
李冬月1,刘晓光2,刘忠军2,姜亮2,韦峰2.颈胸段脊柱转移瘤的手术疗效及生存率[J].,2019,27(17):1556-1560
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
投稿时间:2018-12-31  修订日期:2019-02-19
DOI:
中文关键词: 颈胸段脊柱, 转移性肿瘤, 手术疗效, 生存情况, 预后因素
英文关键词: cervicothoracic junction spine (CTJS) , metastatic tumors, surgical efficacy, survival time, prognostic factor
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作者单位
李冬月1  
刘晓光2  
刘忠军2  
姜亮2  
韦峰2  
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中文摘要:
      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。
英文摘要:
      Abstract:[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, in? cluding tumorectomy in 12 patients and palliative surgery in 18 patients. The visual analogue scale (VAS) for pain, Eastern Co? operative 0ncology Group scale (ECOG) and Frankel index were used for clinical evaluation. The Kaplan-Meier curve for surviv? al 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 tu? mors in medium-low malignant level got the median survival time of 44.00 months, whereas the palliative surgery group had me? dian 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 com? bined visceral metastases significantly impacted the survival time (P<0.05) . [Conclusions] The malignant level of prima? ry tumors and combined visceral metastases have important significances for prognostic assessment of CTJS metastatic tu?mors. Tumorectomy might achieve satisfactory clinical outcomes for the CTJS solitary metastasis of primary tumors in mediumlow malignant level.
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