转移性骨肿瘤897例临床分析

The clinical analysis of 897 patients with metastatic bone tumor

目的总结分析转移性骨肿瘤的发病特点及临床特征。方法回顾性分析1980年1月～2003年12月本院临床诊断为转移性骨肿瘤897例,统计分析转移性骨肿瘤的发病特点及临床特征。结果转移性骨肿瘤好发于男性,以41～70岁多见,原发病灶男性最常见者依次来自肺(25.6%)、前列腺(11.4%)、肝(7.6%),女性则以肺(26.7%)、乳腺(12.1%)、胃肠(5.7%);来源不明占24.0%。早期单发以脊柱、骨盆最为多见,晚期易全身多处转移。患者常因肢体疼痛(51.8%)、肿物(10.5%)、功能障碍(7.7%)、病理性骨折(7.5%)甚至截瘫(3.1%)等就诊,26.8%的患者因原发病灶症状就诊检查时发现骨转移。影像学以溶骨性改变(82.1%)多见。治疗以对症处理、缓解疼痛、化疗、放疗为主,手术多为姑息治疗。结论转移性骨肿瘤的临床特征复杂,应掌握其发病特点,争取早期诊断、早期治疗。

Objective To analyse the epidemiologic and clinical features of metastatic bone tumor. Methods 897 cases with clinical diagnosis of metastatic bone tumor admitted from 1980 to 2003 were reviewed from several aspects. Results Men were 2.2 times more commonly affected than women. It occurred frequently at the age 41 to 70. The most common metastases in men were lung cancer（25.6% ）, prostate cancer （ 11.4% ）, liver cancer（7.6% ）and in women were lung cancer（ 26.7% ） , breast cancer （ 12. 1% ） , alimentary tract tumor （5.7%）. There were also many skeletal metastases of unknown origin（24.0% ）. The spine and pelvis were the most common metastatic sites in the early stage. The main symptom was pain（51.8% ） , although many bone me- tastases were asymptomatic（26.8% ）. The most severe consequences were pathologic fractures（7.5% ）and paraplegia（3.1% ）. The most frequent radiographic pattern was the lytic type （82. 1% ） and followed by osteosclerotic （10. 6% ） and mixed（8.3% ）. Symptomatic treatment and pain relief and chemotherapy and radiotherapy were used as main therapies, while operation was referred only when necessary. Conclusions In spite of complexity, the clinical features should be mastered for early diagnosis and treatment.