年龄对活动脊柱节段骨巨细胞瘤预后的影响

Influence of age factor on the prognosis of giant cell tumor at mobile spine

中文关键词:  脊柱肿瘤  骨巨细胞瘤  复发  预后  年龄

英文关键词:Spinal tumor  Giant cell tumor of bone  Recurrence  Prognosis  Age

中文摘要:

  【摘要】 目的：探讨年龄对活动脊柱节段骨巨细胞瘤预后的影响。方法：回顾我院1989年3月~2011年12月经手术治疗的62例活动脊柱节段骨巨细胞瘤病例，其中男25例，女37例，年龄11~68岁，平均32岁。病变位于颈椎28例，胸椎24例，腰椎10例；单节段36例，≥2个节段26例。术前Enneking分期 S2期2例，S3期60例。根据WBB分期，仅累及后方附件结构2例，仅累及前方椎体结构15例，同时累及前后方结构45例。共53例得到随访，中位随访时间为63个月（5~292个月），非死亡病例随访均超过21个月。以25岁为界进行年龄分组，用SPSS软件研究不同年龄组患者术前影像学累及节段、累及广泛程度的差异。对术前Enneking分期为S3期、手术方式采用包膜外分块切除术的病例，按上述年龄分组方法分组，用Kaplan-Meier统计方法分析两年龄组间无复发生存率的差异；再按年龄每10岁一档进一步分组，通过线性卡方统计方法观察各年龄组间术后复发率的变化趋势。结果：≤25岁组20例，>25岁组42例。≤25岁组累及≥2个节段6例（6/20），>25岁组20例（20/42）例，两组比较无统计学差异（P=0.1）。≤25岁组中，单独累及附件2例，单独累及椎体7例，同时累及前后方结构11例；>25岁组中，单独累及椎体8例，同时累及前后方结构34例，两组肿瘤累及部位有统计学差异（P=0.03）。获得随访的53例患者中，共有18例术后复发，复发率32%；中位复发时间12个月（2~200个月），共有6例复发时间超过术后2年，分别为30、37、38、42、94和200个月。在Enneking分期为S3期（除外恶性骨巨细胞瘤1例）并采用经瘤包膜外分块切除术的35例患者中，≤25岁组12例，无复发，平均无复发生存时间为59.8个月；>25岁组23例，9例复发，平均无复发生存时间为65个月，两组的无复发生存率比较有统计学差异（P=0.03）。将此35例患者按年龄每10岁一档分组，11～20岁组6例，无复发；21～30组13例，3例复发，复发率23%；31～40组6例，2例复发，复发率33.3%；41～50组7例，4例复发，复发率57.1%；线性卡方分析结果显示，各组间复发率呈递增趋势（P=0.02）。结论：在Enneking分期相同并采用相同手术方式的前提下，年龄可能是影响活动脊柱节段骨巨细胞瘤术后复发的因素之一，年轻患者预后较好。

英文摘要:

  【Abstract】 Objectives: To find out whether age factor is associated with the recurrence rate of giant cell tumor at mobile spine. Methods: A retrospective review on cases with giant cell tumor of spine treated at Peking University Third Hospital from March 1989 to December 2011 was performed, this series included 25 males and 37 females, with a mean age of 32 years. 28 cases had defect at cervical spine, 24 at thoracic spine, and 10 at lumbar spine. Radiologically, 36 tumors were limited in 1 vertebra, and 26 in 2 or more. There were 60 cases classified as S3, and 2 cases as S2. According to the WBB Staging Diagram, posterior element was involved in only 2 cases, while vertebral body was involved in 15 cases, and 45 had both sites involved. As for the treatment, intralesional intracapsular excision was performed on 9 cases, intralesional extracapsular excision in 45, and en bloc excision in 8. Routine follow-up was conducted in 53 patients, with a median follow-up of 63 months and a minimum follow-up of 21 months. Vertebral levels involved and vertebral column involved were compared between patients below and above 25yr. Recurrence rate was compared among cases of different age groups with an Enneking stage. Statistical analysis was done by SPSS 19.0. Results: 20 patients were 25yr or below(25yr or below group), and 42 were above 25yr(above 25yr group). There were 6(6/20) cases involved in more than 1 level in the 25yr or below group, while 20(20/42) in the above 25yr group, which showed no statistical significance between two age groups(P=0.1). In the 25yr or below group, 2 cases had defect located at the posterior element of vertebra, 7 at the vertebral body and 11 at both. While in the above 25yr group, none were merely located at the posterior element, 8 at the vertebral body and 34 at both(P=0.03). There were a total of 18(33%) recurrences, with median recurrence duration of 12 months. Among the cases with an Enneking stage of S3 and intralesional extracapsular excision, the relapse free survival rate of 25yr or below group was higher than that of the above 25yr group(P=0.03). When dividing groups of ten yr interval, the recurrence rate was 0%(0/6) in 11-20yr group, 23%(3/13) in 21-30yr group, 33.3%(2/6) in 31-40yr group and 57.1%(4/7) in 41-50yr group, which showed increasing recurrence rate with age. Conclusions: In cases with the same Enneking stage and the same surgical treatment, age appears to be associated with the recurrence rate of giant cell tumor at mobile spine, young patients tend to have better prognosis.