脊柱转移瘤481例的流行病学分析

Epidemiological study of spine metastases: a 481 cases report

中文关键词:  脊柱转移瘤  回顾性分析  多中心研究  流行病学分析

英文关键词:Spinal metastasis tumor  Retrospective study  Multicenter study  Epidemiological analysis

中文摘要:

  【摘要】 目的：总结分析脊柱转移瘤的发病特点和临床特征。方法：对国内3家医院（天津医院、河北医科大学附属第三医院、济南军区总医院）2007年1月~2016年12月所有脊柱转移瘤患者的人口学特征、原发灶来源、侵犯部位、临床症状及治疗方法进行回顾性分析。纳入标准：经临床、影像和病理检查确诊为脊柱转移瘤且医疗资料收录完整。排除标准：仅有临床、影像证据，无明确病理诊断者；不能明确排除脊柱原发肿瘤、结核、退行性病变可能的病例。对复发病例按单例计算。结果：481例脊柱转移瘤患者符合纳入标准，其中男287例（59.7%），女194例（40.3%）；发病年龄18～86岁，中位年龄60.0岁，以50～69岁为高发年龄，平均59.2±11.1岁，男性平均发病年龄59.6±11.5岁，女性平均发病年龄58.5±10.5岁，差异无统计学意义（t=0.277，P＞0.05）。原发肿瘤为肺癌181例，肾癌40例，女性乳腺癌29例，肝癌25例，胃肠肿瘤23例，前列腺癌20例，甲状腺癌、食管癌等肿瘤病例数均小于20例（共70例），来源不明的肿瘤93例；单纯侵及颈椎37例，胸椎135例，腰椎130例，骶椎42例，跨节段（同时累及颈、胸、腰、骶两个及以上节段）的患者137例；就诊时，出现脊髓受压症状及脊柱转移部位局部疼痛的患者281例，单纯脊柱转移部位疼痛128例，只有脊髓受压症状33例，无转移部位症状而在体检中发现脊柱转移39例；有原发肿瘤病史者75例。手术治疗314例，其中266例行开放性手术，48例行经皮椎体成形术（PVP）或经皮球囊扩张椎体成形术（PKP）；保守治疗167例，应用磷酸盐等抗骨质破坏药物、放射性核素治疗、放疗及止痛、全身营养支持等对症治疗。结论：脊柱转移瘤患者中男性多于女性，发病高峰为50～69岁。患者多因脊柱转移病变所致症状就诊，有明确原发肿瘤病史者较少。原发灶多为上皮或腺体来源的脏器肿瘤，尤以肺癌多见，间叶组织来源的肿瘤较少。常见侵袭部位为胸椎、腰椎，临床上以缓解症状、延缓病情发展等姑息性治疗方法为主。

英文摘要:

  【Abstract】 Objectives: To explore the clinical and epidemiological characteristics of patients with spinal metastases. Methods: From January 2007 to December 2016, 481 patients with spinal metastases in three centers were administered. The demographic data, type of primary tumor, location of metastases, clinical feature and therapeutic modality of all the patients were collected and analyzed retrospectively. Inclusion criteria was as following: patients diagnosed with spinal metastases by clinical, iconography and pathological evidences, with complete medical documents available. While patients without pathological evidence, diagnosis of primary spinal tumor not being eliminated, tuberculosis, degenerative diseases, and patients with incomplete medical documents were all excluded. Each relapsing patient was regarded as a single case. Results: All the 481 patients suffered from spinal metastasis met inclusion criteria in this study, including 287 males(59.7%) and 194 females(40.3%). The mean age of all the patients was 59.2±11.1 years old(range, 18-86 years old), and the high peak age of those patients was from 50 to 69 years. The mean age of female group was 58.5±10.5 years old which was slightly younger than male group(59.6±11.5 years), no significant difference was observed(t=0.277, P＞0.05). There were 181 cases of lung cancer, 40 cases of renal cancer, 29 cases of breast cancer, 25 cases of liver cancer, 23 cases of gastrointestinal cancer, 20 cases of prostate cancer; the numbers of thyroid, esophaseal and other cancers were all less than 20, which accounted to 70 in total; 93 cases were with unknown origin of tumor. The most common spinal metastatic site was the thoracic spine(135 cases), followed by the lumbar spine(130 cases), sacral spine(42 cases), cervical spine(37 cases), and salatory metastases(metastases involved more than two sites of the cervical, thoracic, lumbar and sarcum vertebrae) arose in 137 patients. 281 patients were admitted to hospital with complaint of spinal cord compression and pain, while 128 patients with only pain and 33 patients with only spinal cord compression, 39 patients were found spinal metastasis with no symptom in regular checkups, and 75 patients with known primary cancer. The patients were divided into surgery(314 cases) and non-surgery(167 cases) group. Concerning therapeutic modalities, patients in surgery group included 266 patients with open approach, and 48 patients with percutaneous vertebroplasty(PVP) or percutaneous balloon kyphoplasty(PKP), while 167 patients in non-surgery group were treated by bisphosphonates, radionuclide, radiotherapy, and other symptomatic therapies. Conclusions: There is a higher incidence for male to suffer from spinal metastases than female, with a peak age of 50-69 years. Symptoms caused by metastases are the main reasons for visit, and few of them have specific primary tumor history. Primary lesions are largely originated from epithelium and gland of viscera, especially common in lung. But metastases from mesenchymal tumors are relatively rare. Lumbar and thoracic spine are more common involved vertebrae. Palliative therapies are adopted for majority of the patients to relieve clinical symptoms.