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蒋伟刚,刘耀升,刘蜀彬,周诗国,雷明星,范海涛,曹云岑.乳腺癌脊柱转移瘤术后转归及预后因素分析[J].脊柱外科杂志,2017,15(2):111-116.
乳腺癌脊柱转移瘤术后转归及预后因素分析     点此下载全文 (Fulltext)
蒋伟刚1 2  刘耀升2  刘蜀彬2  周诗国3  雷明星2  范海涛2  曹云岑2
1. 安徽医科大学中国人民解放军第307医院临床学院, 安徽 230302;
2. 中国人民解放军第307医院骨科, 北京 100071;
3. 首都医科大学附属北京友谊医院统计室, 北京 100050
基金项目:北京市科委首都临床特色课题(z131107002213052,z161100000516101,z1711000010176)
DOI:10.3969/j.issn.1672-2957.2017.02.009
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摘要:
      目的 探讨乳腺癌脊柱转移瘤患者术后功能转归及影响术后生存期的预后因素。方法 对2010 年1 月-2015 年5 月于解放军第307 医院接受手术治疗的65 例乳腺癌脊柱转移瘤患者临床资料进行回顾性分析。患者分为脊髓压迫(SCC)组(29 例)和无脊髓压迫(NSCC)组(36 例)。评价患者疼痛视觉模拟量表(VAS)评分、体力状态美国东部肿瘤协作组(ECOG)评分、神经功能Frankel 分级改善情况,探讨手术方式、系统内科治疗、患椎辅助放疗、术前内脏转移、术后运动功能状态(Frankel 分级)、术前体力状态(ECOG评分)和受累椎体数目对术后生存期的影响。结果 SCC 组患者VAS 评分由术前(5.7±1.4)分降至术后(2.0±0.9)分,NSCC 组患者VAS 评分由术前(6.2±1.5)分降至术后(2.1±1.2)分;各组术前与术后比较,差异均有统计学意义(P< 0.05)。SCC组15 例(52%)术后神经功能Frankel分级获得改善,14 例(48%)维持不变;术前无行走能力的18 例患者中11 例(61%)术后重新获得行走能力。多变量Cox 分析显示系统内科治疗、术前内脏转移、术前体力状态对患者术后生存期有显著影响。结论 经皮椎体成形术可以快速有效减轻患椎疼痛,后路减压内固定术可以有效改善或延缓SCC 引起的神经功能障碍。此外,系统内科治疗、术前内脏转移和术前体力状态是预测乳腺癌脊柱转移瘤患者术后生存期的重要预后因素。
关键词:脊柱  乳腺肿瘤  肿瘤转移  预后  因素分析,统计学
Postoperative outcome and prognostic factor analysis for spinal metastases from breast cancer    Fulltext
JIANG Wei-gang1 2  LIU Yao-sheng2  LIU Shu-bin2  ZHOU Shi-guo3  LEI Ming-xing2  FAN Hai-tao2  CAO Yun-cen2
1. Clinical College, 307th Hospital of Chinese PLA, Anhui Medical University, Hefei 230302, Anhui, China;
2. Department of Orthopaedics, 307th Hospital of Chinese PLA, Beijing 100071, China;
3. Department of Statistics, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Fund Project:
Abstract:
      Objective To evaluate the postoperative functional outcome and prognostic factors influcencing the survival time in the patients with spinal metastases after surgery for breast cancer. Methods The clinical data of 65 breast cancer patients with spinal metastases operated in 307th Hospital of Chinese PLA from January 2010 to May 2015 were retrospectively analyzed. The patients were divided into the spinal cord compression(SCC) group (29 cases) and non SCC(NSCC) group (36 cases). Improvement of visual analogue scale(VAS) score, Eastern Cooperative Oncology Group(ECOG) score and neurological function Frankel classifation were assessed. The influence of operation method, standard medical treatment (chemotherapy and/or targeted therapy and/or endocrinotherapy), postoperative radiation therapy, preoperative visceral metastases, postoperative ambulatory status(Frankel classification), preoperative performance status(ECOG score) and the number of invaded vertebrae on postoperative survival time were explored. Results In SCC group, VAS score decreased from preoperative 5.7±1.4 to postoperative 2.0±0.9; in NSCC group, VAS score decreased from preoperative 6.2±1.5 to postoperative 2.1±1.2; there was significant difference between pre-operation and post-operation in each group(P< 0.05). In SCC group, Frankel classification of postoperative neurological function was improved in 15 cases(52%), remained unchanged in 14 cases(48%). Eleven of 18 patients(61%) unable to walk regained their ambulatory ability. Multivariable Cox proportional hazards model showed standard medical treatment, preoperative visceral metastases and preoperative ECOG score had significant effect on the postoperative survival. Conclusion Percutaneous vertebroplasty can timely and effectively relieve pain, and posterior decompression can improve and/or postpone neurological deficits. Besides, standard medical treatment, preoperative visceral metastases and preoperative performance status are the main factors influcencing the prognosis of breast cancer patients with spinal metastases.
Keywords:Spine  Breast neoplasms  Neoplasm metastasis  Prognosis  Factor analysis, statistical
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