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○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(x2=0.300,P=0.584).Cox比例风险回归模型分析显示放疗[HR=1.913,95％CI(1.471,2.488),P＜0.001]、化疗[HR=1.313,95％CI(1.040,1.658),P=0.022]、靶向药物治疗[HR=1.683,95％CI(1.221,2.319),P=0.001]、KPS[HR=1.593,95％CI(1.140,2.225),P=0.006]及病理类型[HR=0.322,95％CI(0.225,0.460),P＜0.001]是肺癌脊柱转移瘤患者一年生存率的独立影响因素,差异有统计学意义.结论 手术治疗可显著改善肺癌脊柱转移患者神经功能和一般状态,接受放疗、化疗、靶向药物治疗可改善肺癌转移瘤患者一年生存率,KPS＜50分及原发肿瘤为非腺癌则降低一年生存率.
Abstract
Objective To investigate the risk factors for 1-year survival rate in patients with spinal metastasis secondary to lung cancer.Methods The data of 343 patients with spinal metastases secondary to lung cancer from January 2011 to Decem-ber 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.Results The 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 in-volved vertebral body.58.3％(200/343)of the patients had extraspinal bone metastasis.36.2％(124/343)of the patients had vis-ceral 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 can-cer(5.3％,18/343).The type of lung cancer cells in about 8.2(28/343)patients was unknown.Among the surgical patients,21 pa-tients 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 the median surviv-al time of 8(5,14)months.The survival rates were 62.1％(213/343),30.0％(103/343),and 3.8％(13/343)at 6,12,and 24 months,respectively.The average survival time of patients in the operation group was 10.24 months with the median survival time of 9(5,15)months,and the average survival time of patients in the non operation group was 9.41 months with the median survival time of 7(5,13)months with no significant difference between the groups(x2=0.300,P=0.584).Multivariate Cox proportional hazard re-gression model analysis showed that radiotherapy[HR=1.913,95％CI(1.471,2.488),P＜0.001],chemotherapy[HR=1.313,95％CI(1.040,1.658),P=0.022],targeted drug therapy[HR=1.683,95％CI(1.221,2.319),P=0.001],KPS[HR=1.593,95％CI(1.140,2.225),P=0.006]and pathological type(non-small cell lung cancer)were independent factors affecting the 1-year survival rate of patients with spinal metastasis secondary to lung cancer[HR=0.322,95％CI(0.225,0.460),P＜0.001]with significant difference.Conclusion Surgical treatment can improve both the neurological function and general status of patients with spinal metastasis.Treatments of radiotherapy,chemotherapy,and targeted drug therapy can significantly improve 1-year survival rate,while a KPS less than 50 points and a primary lung cancer other than adenocarcinoma were independent risk factors reducing 1-year survival rate.
维普
万方数据