Tomita评分在脊柱转移癌治疗决策与生存时间预测中的作用

The decision-making and survival prediction role of Tomita score in the management spinal metastases

中文关键词:  脊柱转移癌  Tomita评分  手术  生存时间

英文关键词:Spinal metastases  Tomita score  Surgery  Survival time

中文摘要:

  【摘要】 目的：探讨 Tomita评分在脊柱转移癌治疗决策与生存时间预测中的作用。方法：回顾性分析２００２年１月～２００８年１２月在我院收治的脊柱转移癌患者１０８例，男６６例，女４２例，年龄１７～８６岁，平均５７.９岁。手术治疗４４例，保守治疗６４例。通过Tomita评分系统进行评分，并根据不同分值分为４组，２～３分者为A组；４～５分者为B组；６～７分者为C组；８～１０分者为D组，对４组脊柱转移癌患者的术后生存时间（有完全数据者105例，截尾数据3例）进行统计和生存分析比较。结果：随访２～46个月，平均１4.7个月。末次随访截至于２０１１年７月，有１例存活，失访２例，１０８例总平均生存时间１０.３个月，中位生存时间８个月，１年生存率３１.４８%，其中A组４例，平均生存时间２４.７５个月，中位生存时间１５个月，１年生存率７５%；B组１８例平均生存时间１５.５８个月，中位生存时间１５个月，１年生存率６６.６６%；C组３１例平均生存时间１１.７４个月，中位生存时间１１个月，１年生存率４８.３９%；D组５５例平均生存时间６.６５个月，中位生存时间６个月，１年生存率７.２７%。采用Ｌog-rank检验对资料进行非参数估计对４组生存时间分析提示有显著性差异（P<0.001）。采用Ｓpearman等级相关分析结果表明生存时间与Tomita预后评分呈负相关，Tomita评分分值较低者，其生存时间较长，预后相对较好，二者之间关系系数r=-０.5868（P<0.001）。结论：Tomita预后评分与脊柱转移癌患者的预后密切相关，其评分结果可作为脊柱转移癌保守或手术治疗决策的重要参考指标。

英文摘要:

  【Abstract】 Objectiveｓ: To investigate the decision-making and survival prediction role of Tomita score in the management of spinal metastases. Methods: A retrospective analysis of 108 patients of spinal metastases from January 2002 to December 2008 in our hospital was performed. There were　66 males and 42 females with ａｎ average age of 57.9 years(range, 17 to 86 years). 44 cases underwent surgery, while conservative treatment was indicated for 64 cases. All cases were divided into four groups according to different Tomita scores: group A(2-3 points); group B(4-5 points); group C(6-7 points); group D(8-10 point). The survival time(complete data of 105 cases and censored data of 3 cases) in four groups were analyzed statistically. Results: The follow-up was 2-46 months, with an average of 14.7 months. At final follow-up of July 2011, 1 survival and 2 loss of follow-up were noted. 108 cases had a total average survival time of 10.3 months with the median survival time of 8 months, 1-year survival rate was 31.48%, among which 4 cases in group A had an average survival time of 24.75 months and the median survival time of 15 months, with the 1-year survival rate of 75%; in group B, 18 patients had a mean survival time of 15.58 months, the median survival time of 15 months, and 1-year survival rate of 66.66%; in group C, 31 patients had a mean survival time of 11.74 months, the median survival time of 11 months, and 1- year survival rate of 48.39%; in group D, 55 patients had a mean survival time of 6.65 months, the median survival time of 6 months, 1-year survival rate of 7.27%. Non-parametric estimate of the survival time of 4 groups by using log-rank test analysis showed significant differences(P<0.0001). The survival time and Tomita prognosis score were negatively correlated by using spearman rank correlation analysis, the lower score of Tomita score, the longer survival time and good prognosis, with relative coefficients of -0.5868(P<0.0001). Conclusions： Tomita score is associated with the prognosis of spinal metastases, which acts as a referent to determine the treatment protocols.