骨的孤立性转移瘤的预后相关因素分析

目的]分析骨的孤立性转移瘤预后相关因素,选择恰当的手术方式。方法]2002年5月～2010年5月,共收治134例孤立性骨转移瘤患者,其中男76例,女58例,平均59岁。通过随访了解肿瘤学预后,明确1、3年总体生存率及局部复发率。通过回顾病例,分析年龄、性别、原发肿瘤类型、转移部位、有无病理骨折、有无内脏转移、外科边界以及诊断原发肿瘤至出现转移间隔时间8项因素对总体生存率的影响。利用Kaplan-Meier生存分析(log-rank检验)确定对生存率有影响的单个因素,并通过Cox回归进行多因素分析明确影响预后的独立危险因素。结果]105例患者获得随访,随访率78.4%,中位随访时间32.4个月(3～80个月)。患者1、3年总体生存率和复发率分别为78.9%、40.7%和7.5%、23.8%,中位复发时间16个月。单因素分析结果提示:原发肿瘤为进展较慢的肾癌、甲状腺癌、乳腺癌、前列腺癌,行骨科手术时未出现其他脏器转移,取得广泛外科边界、无病理性骨折的患者预后较好(P<0.05)。多因素分析显示原发为进展较慢的肿瘤,行骨科手术时未出现其他脏器转移以及取得广泛外科边界是影响预后的独立危险因素。取得广泛外科边界同样是影响局部复发率的独立危险因素。结论]原发肿瘤为进展较慢的肾癌、甲状腺癌、乳腺癌、前列腺癌,行骨科手术时未出现其他脏器转移以及取得广泛外科边界是影响预后的独立危险因素。

Surgical treatment of bony solitary metastases

Objective]To determine independent prognostic factors of bony solitary metastases and select the most appropriate surgical approach.Method]Clinical data of 134 patients(76 males and58 females aged from 15 to 86) with bony solitary metastases treated at Peking University People’s Hospital Musculoskeletal tumor center between May 2002 and May 2010 were retrospectively investigated.One and three year overall survival(OS),recurrence rate and 8 prognostic factors were analyzed in this study.Univariate and multivariate analysis were performed to determine the prognostic factors of OS and recurrence rate.Result] One hundred and five patients were followed up with the follow-up time ranged from 3-80 months(median 32.4 months).The 1,3-year overall survival rate and local recurrence rate were 78.9%,40.7% and 7.5%,23.8% respectively(median recurrence time 16 months).Univariate showed primary tumor belong to slow progress tumor such as from kidney,breast,thyroid and prostate,no other organ metastases,adequate surgical margin and no pathologic fracture had better survival rate(P<0.05).Multivariate analysis demonstrated that primary tumor belong to slow progress tumor,no other organ metastases and adequate surgical margin were independent prognostic factors for OS.Adequate surgical margin also belong to independent prognostic factors for local recurrence.Conclusion]The independent prognostic factors of bony solitary metastases are primary tumor belong to slow progress tumor such as from kidney,breast,thyroid and prostate,no other organ metastases and adequate surgical margin.