核素全身骨显像在肾细胞癌患者术后随访中的应用价值

Application value of bone scintigraphy in postoperative follow-up of patients with renal cell cancer

目的探讨核素全身骨显像在肾细胞癌(简称肾癌)患者术后随访中的应用价值,分析肾癌患者术后骨转移的相关影响因素。方法回顾性分析2000年1月至2011年1月157例随访资料完整的肾癌患者术后骨显像结果,根据病理组织学结果、CT、MRI及骨显像随访结果最终确定患者是否发生骨转移,通过单因素分析和多因素Cox模型分析性别、年龄、病理分级、病理分期、骨痛与骨转移发生的关系。结果 157例肾癌患者术后行骨显像检查,共计显像652次,每例患者骨显像次数2～12次。发生骨转移者55例,男45例,女10例。其中多发转移者42例,单发转移者13例。骨显像中转移灶表现为浓聚者35例,浓聚伴缺损者15例,缺损者5例。骨转移发生部位依次为骨盆、腰椎、肋骨、股骨、胸椎、颅骨、肱骨、肩胛骨、胸骨、胫骨、跟骨。单因素及多因素分析结果均显示,患者病理分期、骨痛与骨转移的发生密切相关,而患者的性别、年龄、病理分级、病理类型与骨转移的发生无明显关系。结论骨显像在肾癌术后骨转移的诊断中有重要的应用价值,尤其是病理分期较高、有骨痛的患者,应尽早进行骨显像,以便早期发现骨转移病灶,及时采取有效的治疗。

Objective To investigate the application value of bone scintigraphy in the postoperative follow-up of the patients with renal cell cancer（RCC） and to analyze the factors related to bone metastases.Methods To retrospectively analyze the results of postoperative bone scintigraphy in 157 cases of RCC with the complete follow up data from Jan.2000 to Jan.2011.Bone metastases were confirmed by pathology,CT,MRI and bone scintigraphy follow-up.The univariate analysis and multivariate Cox proportional hazards regression models were used to analyze the relationship between sex,age,pathological type,pathological grade,pathological stage and bone pain with bone metastses.Results 157 cases of postoperative RCC were performed 652 times bone scintigraphy,each case had 2-12 times bone scintigraphy respectively.55 cases were identified with bone metastases,45 males and 10 females.42 cases had multiple bone metastases.13 cases had solitary bone metastases.Metastatic bone lesions manifested increased uptake in 35 cases,increased and defect in 15 cases and defect in only 5 cases.The parts of bone metastases in order of frequency were pelvic bones,lumber vertebra,ribs,femur,thoracic vertebra,skull,humerus,scapula,sternum,tibia and calcanueus.The univariate analysis and multivariate Cox proportional hazards regression models showed bone pain and pathological stage related to bone metastasis,whereas sex,age,pathological type and pathological grade had no relationship with bone metastases.Conclusion Bone scintigraphy has important clinical value in the postoperative follow-up of the patients with RCC,those with bone pain or late pathological stage should undergo bone scintigraphy as early as possible so as to detect the metastatic lesions timely.