355例恶性肿瘤骨转移的临床分析

Clinical analysis of 355 patients with bone metastasis of malignant tumors

目的分析恶性肿瘤骨转移的临床特征，提高肿瘤骨转移的诊治水平。方法对355例恶性肿瘤骨转移患者的发病特点、临床特征及生存期等进行回顾性分析。结果恶性肿瘤骨转移男性多见，原发肿瘤以肺癌（44．5％）、乳腺癌（11．0％）多见。转移部位以胸椎（51．0％）、肋骨（43.1%），腰椎（42．3％）、骨盆（26．8％）等多见。骨转移灶多发常见（83．4％）。75．2％的患者表现为不同程度的疼痛，少数以局部肿块、功能障碍、病理性骨折甚至截瘫为主要临床表现，78例（22．0％）患者无症状。影像学表现以溶骨性破坏为主（82．2％）。采用化疗、内分泌治疗、生物治疗、放疗、姑息性手术、双膦酸盐类药物及止痛等综合治疗。骨痛治疗临床获益率为98．5％，影像学有效率为72．2％。中位生存期为13．9个月，其中前列腺癌骨转移为34．9个月，肝癌骨转移为4．6个月。未合并其他部位或脏器转移者生存期长，中位生存期可达14．7个月，骨转移灶单发与多发者生存期无明显差异。结论恶性肿瘤骨转移应争取早期诊断，其治疗应以提高患者生存质量、延长生存期为目标，以姑息活玎为主，采取综合治疗。

Objective To analyze the clinical characteristics of bone metastasis of malignant tumors. Methods The clinical data and survival time of 355 patients with bone metastasis of malignant tumors were retrospectively analyzed. Results The bone metastasis occurred more frequently in men （male：female = 1.45：1 ）. The most common primary tumors were lung cancer in men and breast cancer in women. The thoracic vertebrae, ribs, lumbar vertebrae and pelvic were frequently involved metastatic sites and the multiple bone metastasis was common （83.4%）. The main symptom was pain （75.2%）. Local masses, disfunctions, pathologic fracture and paraplegia occurred in a few patients while many patients were asymptomatic （22.0%）. The most frequent radiographic manifestation was the osteolytic bone destruction （82.2%）. Integrated treatments were taken, including chemotherapy, hormonal therapy, biological therapy, radiotherapy, surgery, bisphosphonate analgeticas, etc. The clinical benefit rate in pain relief was 98.5% and the effective rate was 72.2% in radiographic imaging. The median survival time was 13.9 months. Among them, it was 34.9 months in prostate cancer and 4.6 months in hepatocellular carcinoma. The survival time was longer in bone metastasis without other organ metastasis. There was no significant difference between the single and multiple bone metastases regarding the survival time. Conclusion It is important to master the clinical features of bone metastasis of malignant tumors for early diagnosis and treatment, and to improve the quality of life and prolong the survival time.