乳腺癌脊柱转移瘤术后转归及预后因素分析

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(P0.05)。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。

Postoperative outcome and prognostic factor analysis for spinal metastases from breast cancer

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.