骨盆转移癌外科治疗患者获益情况的随访分析

目的 探讨外科治疗在提高骨盆转移癌患者生存质量中的效果。方法 回顾性分析67例骨盆转移癌患者的外科治疗情况，并随访生存情况、术后国际骨与软组织肿瘤协会（MSTS）评分、疼痛视觉模拟（VAS）评分及体力状态（KPS）评分。根据设定的手术日期（2007年1月1日）分组，分别记录与比较该日期前后行手术者的MSTS、VAS和KPS评分及中位生存期（OS）。结果 全部病例均获随访，随访1～90个月，中位随访15.5个月，其中＞6个月者35例，＞12个月者30例；其中随访＞6个月者的5年总生存率为42.9％，中位OS为46.0月，其中不同原发肿瘤中位OS的差异有统计学意义（P＜0.05），但不同年龄段、性别及外科边界的中位OS比较，差异均无统计学意义（P＞0.05）；全组MSTS评分为（22.9±3.4）分，不同转移灶分区的MSTS评分的差异无统计学意义（P＞0.05），重建者的MSTS评分高于未重建者（P＜0.05），术后VAS和KPS评分均优于术前，差异有统计学意义（P＜0.05）。2007年1月1日后实施手术者的VAS评分降低值、KPS评分升高值、MSTS评分及中位OS均优于此日期之前者（P＜0.05）。结论 骨盆转移癌通过在严格掌握手术适应证的基础上实施有效的外科治疗，可以缓解局部疼痛和改善患者的生活质量。

Follow-up analysis of surgical treatment for patients with metastatic carcinoma in the pelvis

Objective To explore the improvement effect of surgical treatment on quality of life of patients with metastatic carcinoma in the pelvis. Methods A retrospective analyze was carried out on the surgical treatment of 67 patients with metastatic carcinoma in the pelvis from November 1984 to September 2011 in our hospital. The survival data,musculoskeletal tumor society（ MSTS）,visual analog scale（ VAS） and Karnofsky performance scale（ KPS） were followed up. The medium overall survival（ OS） and scores of MSTS,VAS and KPS were analyzed before and after January 1,2007. Results All patients were followed for 1-90 months（ median： 15.5 months）. Thirty-five cases were followed for more than 6 months and 30 cases were followed for more than 12 months.Among 35 patients with more than 6-month follow-up,the 5-years overall survival rate was 42. 9% and the median OS was 46. 0months. Significant difference was observed among patients with different primary tumors（ P〈0. 05）,but not among patients with different age,sex and surgical border（ P〉0. 05）. The overall MSTS was 22. 9 ± 3. 4 and a higher MSTS score was in reconstruction versus non-reconstruction（ P〈0. 05）. The postoperative VAS and KPS were superior to those preoperative with statistical significance.The decreased value of VAS,increased value of VAS,MSTS score and median OS after January 1,2007 were superior to those before January 1,2007（ P〈0. 05）. Conclusion For pelvic metastases,surgical treatment should be given without delay based on the indications for surgery,which can effectively relieve pain,recover activity and improve the life quality of patients.