有限切除手术治疗肺癌脊柱转移瘤失血量及输血需求影响因素分析

Risk factors of blood loss and blood transfusion requirements in limited resection surgery for spinal metastases of lung cancer

中文关键词:  脊柱转移瘤  肺癌  有限切除手术  术中失血及输血  表皮生长因子受体突变

英文关键词:Spinal metastases  Lung cancer  Limited resection  Intraoperative blood loss and blood transfusion  Epidermal growth factor receptor targeted therapy

中文摘要:

  【摘要】 目的：探讨有限切除手术治疗肺癌脊柱转移瘤失血量及输血需求的影响因素。方法：回顾性分析2017年1月1日~2022年12月31日在广东省人民医院因肺癌脊柱转移行有限切除手术的97例患者资料，其中男61例，女36例，年龄60.2±10.1岁。收集患者的性别、体质指数（body mass index，BMI）、手术时间、内固定螺钉个数、病灶减压节段数、有无表皮生长因子受体（epidermal growth factor receptor，EGFR）突变、肺癌病理类型、术前是否化疗、是否为首发骨转移、转移灶所在节段、手术类型、硬膜外脊髓压迫（epidural spinal cord compression，ESCC）评分，术前48h国际标准化比率（international normalized ratio，INR）、红细胞（red blood cell，RBC）计数、白细胞（white blood cell，WBC）计数、血小板（platelets）计数、血钙（blood calcium），Revised-Tokuhashi预后评分等因素，采用单因素及多因素线性回归评估不同因素对术中失血量的影响，单因素及多因素Logistic回归分析方法评估不同因素对输血需求的影响。结果：97例肺癌脊柱转移患者术中失血量为20~4800mL（916±939mL），其中56例患者因术中失血有输血需求。有输血需求的患者较未输血的患者内固定螺钉个数更多，EGFR突变比例更高，首发骨转移比例更低，胸椎转移灶比例更高，术前48h红细胞计数更低。影响术中失血量的显著因素包括手术时间（β=107.1，P=0.026）、内固定螺钉个数（β=108.3，P=0.023）及EGFR突变（β=369.7，P=0.048）等因素。影响术中输血需求的显著因素包括内固定螺钉个数[比值比（odds ratio，OR）=1.7，95%可信区间confidence interval（CI）=1.2~2.3，P=0.001]、EGFR突变（OR=0.1，95%CI=0.0~0.5，P=0.003）、首发骨转移（OR=3.8，95%CI=1.2~11.9，P=0.023）、术前48h RBC计数（OR=0.3，95%CI=0.1~0.7，P=0.009）。结论：手术侵袭性增加和EGFR突变是肺癌脊柱转移瘤患者接受有限切除术术中出血量和输血需求增加的危险因素，非首发骨转移和术前RBC计数降低的患者具有更高的术中输血需求。

英文摘要:

  【Abstract】 Objectives: To explore the risk factors of blood loss and blood transfusion requirements in limited resection for spinal metastases of lung cancer. Methods: The data of 97 patients who underwent limited resection for spinal metastases of lung cancer in Guangdong Provincial People′s Hospital from January 1, 2017 to December 31, 2022 were continuously collected, including 61 males and 36 females, aged 60.2±10.1 years old. The gender, body mass index(BMI), operative time, number of internal fixation screws, number of decompressed segments, epidermal growth factor receptor(EGFR) mutation, lung cancer pathology, preoperative chemotherapy status, bone metastasis at first diagnosed, location segment of metastasis, type of surgical procedure, epidural spinal cord compression(ESCC) classification, preoperative 48-hour international normalized ratio(INR), preoperative 48-hour red blood cell(RBC) count, preoperative 48-hour white blood cell(WBC) count, preoperative 48-hour preoperative platelet count, preoperative 48-hour blood calcium level, the Revised-Tokuhashi prognostic score were collected. Univariate and multivariate linear regression analyses were employed to assess the impact of various factors on intraoperative blood loss, while univariate and multivariate logistic regression analyses were utilized to evaluate the influence of different factors on the transfusion requirement. Results: Intraoperative blood loss ranged from 20 to 4800 mL(mean 916±939mL), and 56 patients required intraoperative blood transfusion. Compared to patients without transfusion, those requiring blood transfusion had a higher number of pedicle screws implanted, a greater proportion of EGFR mutation, a lower proportion of bone metastasis at first diagnosed, a higher proportion of thoracic vertebra metastases, and lower preoperative 48-hour RBC count. Significant factors influencing intraoperative blood loss included operative duration(β=107.1, P=0.026), number of pedicle screws implanted(β=108.3, P=0.023), and EGFR mutation (β=369.7, P=0.048). Significant factors associated with transfusion requirements included the number of pedicle screws implanted[odds ratio(OR)= 1.7, 95% confidence interval(CI)=1.2-2.3, P=0.001], EGFR mutation(OR=0.1, 95%CI=0.0-0.5, P=0.003), bone metastasis at first diagnosed(OR=3.8, 95%CI=1.2-11.9, P=0.023), and preoperative 48-hour RBC count(OR=0.3, 95%CI=0.1-0.7, P=0.009). Conclusions: Increased surgical invasiveness and the presence of EGFR mutation were associated with greater intraoperative blood loss and transfusion requirements in patients undergoing limited resection for spinal metastases of lung cancer. Additionally, patients with non-bone metastasis at first diagnosed exhibited higher transfusion requirements.