非小细胞肺癌脊柱转移患者的术后生存期与相关因素分析

Analysis of postoperative survival and risk factors in patients with spinal metastases from non-small cell lung cancer

中文关键词:  非小细胞肺癌  脊柱转移  手术治疗

英文关键词:Non-small cell lung cancer  Spinal metastasis  Surgical treatment

中文摘要:

  【摘要】 目的：探讨非小细胞肺癌脊柱转移患者的术后生存期及相关因素。方法：回顾性收集2012年1月～2022年1月在我院接受手术治疗的105例非小细胞肺癌伴脊柱转移患者的临床资料，男54例，女51例，平均年龄56.8±11.1岁。根据术式将患者分为三组，次全脊椎切除+骨水泥隔离组（n=33）、经瘤分块全脊椎切除组（n=46）及整块全脊椎切除组（n=26）。记录患者的人口学特征、实验室检验结果、影像学检查结果（包括脊柱受累情况、脊柱外骨转移情况、内脏转移情况等）及病理学检查结果等。通过Frankel分级、卡氏评分（Karnofsky performance scale，KPS）、ECOG（Eastern Cooperative Oncology Group）评分等评估患者在术前及随访1年时的神经功能及一般情况。使用Kaplan-Meier法评估患者的1年生存率，通过单因素分析（Log-rank检验）筛选患者预后的影响因素，并通过多因素分析（Cox回归模型）确认影响患者预后的独立相关因素。结果：全部病例术后恢复良好。6例术后出现切口感染，其中5例经抗感染治疗及切口换药后痊愈，1例经清创缝合术后痊愈。7例出现脑脊液漏，4例出现胸腔积液，经对症治疗后均恢复。平均随访时间为14.4±7.3个月。平均KPS评分由术前的65.4±18.0分提高至术后的75.1±17.6分，Frankel分级为D和E的比例由术前的65.7%提升至术后的81.0%，ECOG评分为0～1分的比例由术前的40.0%提高至术后的69.5%。105例患者的总体生存期为19.8±1.4个月，无复发生存期为15.1±0.8个月。根据Cox回归分析，术前ECOG评分（P=0.002）、内脏转移（P<0.001）、手术方式（P=0.02）及是否接受免疫治疗（P=0.002）为影响肺癌脊柱转移患者术后总体生存期的独立相关因素。结论：手术治疗可显著改善肺癌脊柱转移患者一般状态和神经功能，不同手术方式对缓解临床症状无显著差异，但整块全脊椎切除术可有效降低肿瘤术后复发。术前ECOG评分、内脏转移、手术方式以及免疫治疗为影响患者总体生存期的独立相关因素。

英文摘要:

  【Abstract】 Objectives: To investigate the postoperative survival and risk factors in patients with spinal metastases from non-small cell lung cancer. Methods: The data of 105 patients with non-small cell lung cancer and spinal metastases who were surgically treated at our hospital between January 2012 and January 2022 were retrospectively collected. The patients were divided into three groups based on the surgical procedure, corpectomy with bone cement isolation group(n=33), piecemeal total spondylectomy group(n=46), and total en bloc spondylectomy group(n=26). Demographic characteristics, laboratory test results, radiological examination findings(including spinal involvement, non-spinal bone metastases, visceral metastases, etc.) and pathological examination results were recorded. Patients′ neurological function and general condition were assessed using the Frankel classification, Karnofsky performance scale(KPS) score and Eastern Cooperative Oncology Group(ECOG) score preoperatively and at 1-year follow-up. The 1-year survival rate was evaluated using the Kaplan-Meier method. Risk factors affecting prognosis were identified through univariate analysis(Log-rank test) and confirmed by multivariate analysis(Cox regression model). Results: All the cases had good postoperative recovery. Six cases developed incision infections, of which five healed after antibiotic treatment and dressing changes, while one healed after debridement. Seven cases experienced cerebrospinal fluid leakage, and four developed pleural effusions; All recovered after symptomatic treatment. The average follow-up time was 14.4±7.3 months. The average KPS score of the patients improved from 65.4±18.0 preoperatively to 75.1±17.6 postoperatively. The proportion of patients classified as Frankel grades D and E increased from 65.7% before surgery to 81.0% after surgery. The proportion of patients with ECOG scores of 0-1 increased from 40.0% preoperatively to 69.5% postoperatively. The overall survival of the 105 patients was 19.8±1.4 months, and the recurrence-free survival was 15.1±0.8 months. According to Cox regression analysis, preoperative ECOG score(P=0.002), visceral metastasis(P<0.001), surgical procedure(P=0.02), and immunotherapy(P=0.002) were the independent risk factors affecting the overall survival of patients with spinal metastases from non-small cell lung cancer after surgery. Conclusions: Surgical treatment can significantly improve the neurological function and general condition of patients with spinal metastases from lung cancer. There are no significant differences in the alleviation of clinical symptoms between different surgical methods, but total en bloc vertebrectomy can effectively reduce postoperative tumor recurrence. Preoperative ECOG score, visceral metastasis, surgical approach and immunotherapy are independent risk factors affecting the overall survival of patients.