脊柱骨巨细胞瘤外科治疗复发相关因素的回顾性分析

A retrospective study of factors affecting recurrence of giant cell tumor of the spine

目的回顾性分析我院经外科治疗的脊柱骨巨细胞瘤(GCT)患者的临床信息,找出其中与肿瘤复发相关的关键因素。方法回顾性分析1995年1月至2009年3月我院收治的具有完整临床病理及随访资料的156例脊柱GCT病例。单因素分析患者的年龄、性别、肿瘤节段、Campanacci影像学分级、Jaffe病理学分级、既往有无复发史、手术方式(囊内刮除、扩大刮除、全脊椎整块切除和分块切除)等7项临床指标与肿瘤复发的关系。影响复发的多变量相关分析采用逻辑回归方法。结果 156例患者中外院手术复发后来我院就诊25例,首次来我院就诊131例;男71例,女85例,年龄16～68岁,首次发病平均年龄为31岁;肿瘤部位在颈椎34例(21.8%),胸椎52例(33.4%),腰椎31例(19.8%),骶尾椎39例(25.0%),累及2个以上椎节者11例。采取病灶囊内刮除39例,扩大刮除64例,全脊椎切除53例。随访时间18～165个月,平均59个月,绝大多数患者术后近期疗效满意。术后复发45例,其中再手术34例,3次手术3例,4次手术2例;31例患者首次复发在术后2年之内。病灶囊内刮除、广泛刮除、全脊椎切除术后肿瘤复发率分别为46.15%、26.56%、18.87%。单因素分析显示手术方式与脊柱GCT复发具有相关性,多因素逻辑回归分析显示手术方式是影响脊柱GCT复发的重要因素。结论手术方式是影响脊柱GCT复发的重要因素。全脊椎切除能显著降低局部复发率。手术后2年内密切随访十分重要。

Objective A retrospective study based on the clinical information of patients who have been treated on giant cell tumor（C, CT） of the spine, find out the key factors associated with recurrence. Methods One hundred and fifty six patients who have been treated on GCT of spine at the Changzheng Hospital from 1995 1o 2009 were included in this study. All tumors were histologically certified as GCT. Statistical analysis was done with SPSS 11.0. The statistical significance was determined using -K2 test and logistic regression. Results One hundred and thirty-one patients received their first surgical treatment on GCT at our hospital, while 25 were referred from other hospitals due to local recurrence or special surgical difficulties. Eighty-five patients were female, 71 male. The mean age at first diagnosis of the patients was 131 years （16-68 years）. The mean follow-up was 59 months （18 165 months）. Forty five of 156 cases recurred. The recurrence rate of total spondylectomy group （include en-bloc resection and piecemeal resection） was 18. 87%. And recurrence rates of curettage with or without of extensive procedure were 26. 56% and 46. 15%. Surgical method was related with the recurrence. Moreover, logistic regression revealed that the surgical method significantly affected the recurrence. Conclusions Surgical method significantly affected the recurrence. Total spondylectomy can reduce local recurrence. The close follow-up in 2 years after surgery is very important.