摘要
目的探讨非小细胞肺癌(non-small cell lung cancer,NSCLC)胸椎转移的外科治疗策略及预后因素。方法回顾性分析河北医科大学第四医院骨科2006-01-01-2012-01-31收治,符合纳入标准的35例NSCLC胸椎转移接受手术治疗且随访完整的患者临床资料。应用Kaplan-meier生存分析和Cox回归对患者的原发病灶是否切除、是否应用前路手术、术后ASIS评分以及术前和术后KPS评分等11项因素进行分析。结果 35例患者术后中位生存时间为18.4个月。其中单纯前路胸椎转移癌切除12例,前路胸椎转移癌联合肺癌切除8例,后路椎板减压内固定手术13例,前后路联合手术切除2例。单发的胸椎病灶(P=0.005)、应用前路手术(P<0.001)、无远处内脏转移(P=0.028)、原发灶的切除(P=0.004)、术后患者ASIS评分能够行走(P<0.001)以及术后KPS评分≥70(P<0.001)的患者获得了良好的预后。以上因素的多因素分析结果显示,术后患者ASIS评分能够行走(P=0.001)、切除原发灶(P=0.002)以及应用前路手术(P=0.023)是影响患者术后生存率的独立影响因素。结论应根据NSCLC胸椎转移癌患者的整体情况及病变的特点,选择适宜的手术方式,以提高患者的生存质量,应用前路手术切除转移癌及切除原发灶可能使患者的生存期延长。
OBJECTIVE To investigate surgical strategy and prognostic factors of thoracic metastasis from non- small cell lung （NSCLC） cancer. METHODS A total of 35 patients with thoracic metastasis from non-small cell lung cancer,who had undergone surgical treatment from January 1,2006 to January 31,2012 and had complete follow-up data, were enrolled in this retrospective study. Kaplan-meier survival curve and Cox regression model were performed to identify prognostic factors among 11 factors including whether lung surgery was performed, whether performed anterior approach operation, the ASIS scores in post-operation and KPS scores in pre-operation and post-operation. RESULTS The 35 patients＇ median survival time was 18. 4 months. The surgical techniques included vetebreetomy with fixation of anteriot transcavitary approach in 12, vetebrectomy and lobectomy by one-stage operation of anterior transcavitary approach in 8, debulking with fixation of posterior in 13 and debulking with fixation of anterior and posterior transcavitary approach in 2. Univarite analysis showed the significant prognostic factors include number of thoracic metastasis （P=0. 005） ,anterior approach operation （P〈0. 001） ,visceral metastasis （P=0. 028） ,lung surgery （P=0. 004） ,the ASIS scores in post-operation （P〈0. 001）and KPS scores in post-operation （P〈0. 001）. Multivariate analysis showed the independent prognostic factors were the ASIS scores in post-operation （ambulation, p= 0. 001）, performed anterior approach operation （p=0. 023） and the lung surgery was performed （P=0. 002）. CONCLUSIONS According to the whole body situation and the characteristics of the lesion of NSCLC patients with thoracic metastasis, the proper surgical procedure will be performed. Resection for the primary tumor and thoracic metastatic lesions by anterior approach operation of non-small cell ung cancer still have a chance to obtain long-term survival.
出处
《中华肿瘤防治杂志》
CAS
北大核心
2014年第19期1529-1533,共5页
Chinese Journal of Cancer Prevention and Treatment
基金
河北省卫生厅重点资助课题(20120131)
关键词
非小细胞肺癌
NSCLC
胸椎
肿瘤转移
预后
non-small cell lung carcinoma
NSCLC
thorax
neoplasms metastasis
prognosis
