北京大学学报(医学版) ›› 2014, Vol. 46 ›› Issue (1): 138-143.

• 论著 • 上一篇    下一篇

肺癌脊柱转移瘤的手术治疗疗效及生存分析

李彦,姜亮,刘晓光,刘忠军△,韦峰,吴奉梁,党礌   

  1. (北京大学第三医院骨科,北京100191)
  • 出版日期:2014-02-18 发布日期:2014-02-18

Efficacy and survival rate analysis of lung cancer with spinal metastases

LI Yan, JIANG Liang, LIU Xiao-guang, LIU Zhong-jun△, WEI Feng, WU Feng-liang, DANG Lei   

  1. (Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China)
  • Online:2014-02-18 Published:2014-02-18

摘要: 目的:探讨肺癌脊柱转移瘤的手术治疗疗效和预后影响因素。方法:对2005年4月至2012年4月在北京大学第三医院骨科住院治疗且病 理诊断明确的35例肺癌脊柱转移瘤患者的临床资料进行回顾性分析。根据治疗方法不同分为手术治疗组和保守治疗组,比较手术组患者手术前 后的疼痛程度、生活质量及神经功能状态;分析患者的生存期与放射治疗、内科治疗(化学治疗和/或靶向治疗)、手术治疗、神经功能状态和 生活质量的关系。结果:28例(80%, 28/35)获得随访资料,手术组22例,保守组6例。手术组疼痛程度和生活质量明显改善:视觉疼痛评分( visual analog scale, VAS)的中位数从术前的7分下降至术后3分(z=4.143, P<0.05),Karnorfsky日常状态评分的中位数从术前的50分上升 至术后60分(z=3.825, P<0.05)。手术组有13例伴神经功能损害的患者术后神经功能明显改善(z=2.530, P<0.05)。生存分析结果显示内科 治疗对肺癌脊柱转移瘤患者的生存期有显著影响(P=0.001),手术治疗、放射治疗、神经功能状态和生活质量对生存期无明显影响。结论:手 术治疗肺癌脊柱转移瘤能有效缓解患者的疼痛程度,提高生活质量,改善神经功能;影响肺癌脊柱转移瘤患者生存期的主要因素是内科治疗。

关键词: 脊柱肿瘤, 肺肿瘤, 肿瘤转移, 外科手术, 生存分析

Abstract: Objective: To explore the efficacy of surgical treatment and the prognosis factors of spinal metastases secondary to lung cancer. Methods: From April 2005 to April 2012, 35 patients diagnosed as spinal metastases secondary to lung cancer were reviewed retrospectively. All the patients were divided into surgical group and conservative group. Severity of pain, neurological status and quality of life preoperatively and postoperatively were compared; and the relevance between their survival time and radiotherapy, medical therapy (chemotherapy and/or targeted therapy), surgical treatment, quality of life, and neurological status were evaluated. Results: Of all the patients, 28 (80%, 28/35) had been followed up. The surgical group contained 22 cases and the conservative group 6. The severity of pain and quality of life improved significantly in the surgical group. The median of visual analog scale for pain reduced from 7 points to 3 points (z=4.143, P<0.05); the median of Karnorfsky performance score increased from 50 points to 60 points (z=3.825, P<0.05). For the 13 patients in the surgical group who had neurological deterioration, the improvement of Frankel grade was statistically different (z=2.530, P<0.05). The survival analysis indicated that medical therapy had significant association with longer survival (P=0.001). However, surgery, radiotherapy, neurological status and quality of life had no direct relations with survival time. Conclusion: Surgical treatment for spinal metastases secondary to lung cancer can effectively relieve the pain, improve the quality of life and neurological status. The survival time is largely influenced by medical therapy.

Key words: Spinal neoplasms, Lung neoplasms, Neoplasm metastasis, Surgical procedures, operative, Survival analysis

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