肾透明细胞癌脊柱转移的手术效果及生存期相关因素研究

Surgical effect and survival-related factors study for patients with spinal metastasis of renal clear cell carcinoma

中文关键词:  肾透明细胞癌  脊柱转移瘤  手术治疗  手术效果

英文关键词:Renal clear cell carcinoma  Spinal metastasis  Surgical treatment  Surgical effect

中文摘要:

  【摘要】 目的：探索肾透明细胞癌脊柱转移的手术治疗效果以及生存期相关因素。方法：回顾2008年1月～2019年12月于我科行手术治疗的肾透明细胞癌脊柱转移患者45例，其中男性34例，女性11例，平均年龄60.1±7.6岁，平均病程为4.3±4.4个月（1~24个月）。术前Frankel分级E级25例，D级17例，C级1例，B级2例。术前伴有内脏转移10例，伴有其他骨转移16例。按手术方式分为肿瘤切除组和姑息减压组，肿瘤切除组包括肿瘤减灭术和全脊椎切除术。统计手术出血量及手术相关并发症，对所有患者进行随访，根据患者的生存状态分为终点组（已去世）和随访组（仍存活），记录随访组患者的疼痛缓解情况、生活自理能力、神经功能评估及随访前半年内的影像学复查结果。通过Kaplan-Meier法估算中位生存期并获得生存曲线。将可能影响患者生存期的因素进行单因素分析，将单因素分析中有统计学差异的因素纳入多因素COX回归分析。结果：随访时间均为12个月以上，末次随访时仍有30例患者存活（随访组），平均随访时间为36.7±31.6个月，手术后的中位生存期为81.0个月，术后1年生存率为84.4%，术后2年生存率为78.6%，术后3年生存率为70.2%。随访组患者术前和随访时的NRS评分平均值分别为6.0±2.4分（1~10分）和2.9±2.7分（0~8分），19例患者与术前相比疼痛明显缓解（NRS评分降低3分以上）。术前和随访时的KPS评分平均值分别为71.3±14.3分（30~90分）和70.0±12.2分（40~90分）。29例患者随访时的Frankel分级为D级以上，其中6例获得改善，14例保持不变。单因素分析中颈椎转移（P=0.040）、内脏转移（P=0.018）、术后放疗（P=0.027）和术后靶向治疗（P=0.018）对术后生存期的影响有统计学意义，肿瘤切除组的患者预后优于姑息减压组，多因素分析的结果无统计学意义。结论：手术后局部放疗和全身靶向治疗的多学科综合治疗可以提高肾透明细胞癌脊柱转移患者的生存期，手术治疗可以缓解疼痛，保护神经功能，从而提高生活质量。

英文摘要:

  【Abstract】 Objectives: This study aims to explore the effect of surgical treatment and survival-related factors of patients with spinal metastasis of renal clear cell carcinoma. Methods: The data of 45 patients who underwent surgery for spinal metastasis of renal clear cell carcinoma from January 2008 to December 2019 were retrospectively analyzed. Of the patients, there were 34 males and 11 females with a mean age of 60.1±7.6 years and an average course of disease of 4.3±4.4 months (range 1 to 24 months). And 25 patients were of Frankel grade E, 17 were of grade D, 1 of grade C and 2 of grade B before operation. Among the patients, 10 were with visceral metastasis and 16 were with extraspinal bone metastasis. The patients were divided into tumor resection group(with debulking surgery and total spondylectomy) and palliative decompression group according to the surgical options. Intraoperative blood loss and surgical complications were collected. All the patients were followed up, and they were divided into terminal group(died) and follow-up(alive) group according to the survival status. Pain relief, quality of life, nerve function evaluation, and radiological examination result within six months before follow-up of the follow-up group of patients were recorded. Median overall survival and survival curve were obtained via Kaplan-Meier method. Univariate analysis was performed for all the factors possibly related to survial, after which, multivariate COX analysis was performed for factors with statistical difference. Results: The minimum follow-up time was 12 months. At final follow-up, there were 30 patients in follow-up group and the average follow-up time was 36.7±31.6 months. Median overall survival was 81.0 months. One-year, two-year and three-year survival rates after surgery were 84.4%, 78.6% and 70.2%, respectively. In follow-up group, the average numeric rating scale(NRS) score was 6.0±2.4(1 to 10) before surgery and 2.9±2.7(0 to 8) at follow-up. 19 patients obtained obvious pain relief after surgery(NRS score reduced more than 3). The average KPS score was 71.3±14.3(30 to 90) before surgery and 70.0±12.2(40 to 90) at follow-up time. 29 patients were Frankel D or E at final follow-up, and among which 6 improved and 14 remained the same compared with pre-operation. Cervical spinal metastasis(P=0.040), visceral metastasis(P=0.018), postoperative radiotherapy(P=0.027) and targeted therapy(P=0.018) were significantly associated with the survival time after surgery in the univariate analysis. The surgical effect in tumor resection group was better than palliative decompression group, and there was no significant difference in the multivariate analysis. Conclusions: Multidisciplinary therapy after surgery including, radiotherapy and targeted therapy could prolong the survival for patients with spinal metastasis of renal clear cell carcinoma. Surgical treatment could relieve pain, preserve nerve function, and therefore improve the quality of life.