390例病理确诊转移性骨肿瘤的临床分析

Clinical Features of Pathologically Confirmed Metastatic Bone Tumors - a Report of 390 Cases

背景与目的:随着影像、病理等诊断技术的提高,转移性骨肿瘤的早期诊断得到明显改善,但其临床特点复杂,少见报道。本文旨在总结分析经过病理确诊的转移性骨肿瘤病例的临床特点,以进一步提高临床早期诊断和治疗水平。方法:回顾性分析1980年1月至2003年12月我院病理确诊的转移性骨肿瘤390例,总结转移性骨肿瘤的病史、好发部位、临床表现、影像学等临床特点。结果:390例转移性骨肿瘤中,男女比为2.12∶1,中位年龄55.7岁,41岁以上者占81.5%。原发肿瘤依次为肺癌85例(21.8%)、前列腺癌51例(13.1%)、乳腺癌29例(7.4%)、肝癌25例(6.4%)、胃肠癌22例(5.7%);来源不明占96例(24.6%)。脊柱受累占47.7%,其次为骨盆18.2%、股骨15.4%、肋骨12.6%,全身多处转移占20.5%。患者常因骨痛(53.3%)、肿物(14.1%)、病理性骨折(10.3%)、功能障碍(4.9%)甚至截瘫(2.1%)等就诊。原发瘤先被发现的占29.7%,中位转移时间为319天,70.3%的患者不能确定骨转移时间。影像学以溶骨性改变(80.7%)多见,其次为成骨性改变(10.5%)、混合型。结论:转移性骨肿瘤的临床特征复杂,但仍有一定的规律性:(1)转移性骨肿瘤好发于41岁以上的患者;(2)肺癌、前列腺癌、乳腺癌、肝癌最常发生骨转移,以脊柱受累最为常见,其次为骨盆、股骨、肋骨;(3)临床表现多样而无特异性;(4)影像学表现以溶骨性破坏为主;(5)原发灶不明占24%,应掌握其发病特点争取早期诊断、早期治疗。

BACKGROUND ＆ OBJECTIVE. With the development of diagnostic techniques of imaging and pathology, early diagnosis of metastatic bone tumors has been greatly improved, but the clinical characteristics which are essential for diagnosis are rarely reported. In this article, the clinical features of pathologically confirmed metastatic bone tumors were analyzed for further improvement of early diagnosis and treatment. METHODS： Clinical data of 390 patients with pathologically confirmed metastatic bone tumors, treated from 1980 to 2003 at The First Affiliated Hospital of Sun Yat-sen University, were reviewed respectively to summarize the clinical features, including disease history, predilection sites, clinical manifestation, and imaging presentations. RESULTS. Of the 390 patients, the ratio of men to women was 2.12：1 ; the median age was 55.7 years, and 81.5% of the patients were over 41 years old. The primary tumors were lung cancer （21.8%）, prostate cancer （13.1%）, breast cancer （7.4%）, liver cancer （6.4%）, gastrointestinal cancer （5.7%）, and unknown cancers （24.6%）. The common metastatic sites were spine （47.7%）, pelvis （18.2%）, femur （15.4%）, and rib （12.6%）. Multiple metastases occurred in 20.5% of the patients. The main symptoms were skeletal pain （53.3%）, pathologic fractures （10.3%）, dysfunction （4.9%）, and paraplegia （2.1%）. Primary tumor detected before metastasis accounted for 29.7% of the patients with a median metastatic time of 319 days, and the metastatic intervals were uncertain in 70.3% of the patients. Osteolytic types accounted for 80.7% of the cases in radiographic patterns, followed by osteosclerotic （10.5%） and mixed types. CONCLUSIONS： Metastatic bone tumors most frequently occur in patients older than 41 years, and commonly originate from lung, prostate, breast, and liver. Vertebrae, pelvis, femur, and rib are the most common sites of metastases. The clinical manifestation is extensive and nonspecific. Most lesions present osteolytic patterns. Metastases with unknown origin account for 24%. In spite of complexity, the clinical features should be mastered for early diagnosis and treatment.