99例股骨上段骨转移癌患者临床预后因素分析

Analysis of clinical prognostic factor for 99 patients with metastases of proximal femur

目的:探讨股骨上段转移性肿瘤的临床特征和影响预后的相关因素。方法:回顾性分析2003年至2011年在本中心接受手术治疗的99例股骨上段转移性肿瘤患者的临床资料,患者中位年龄56岁(15～87岁),肿瘤来源以肺癌最为常见,其次为乳腺癌。应用Kaplan-Meier曲线计算总体生存率,应用对数秩检验对各种因子进行单因素分析,应用Cox回归分析独立危险因素。结果:患者术后平均随访8.43个月(1～44个月),其中9例在本研究随访终止时仍带瘤存活。患者半年总体生存率55.7%,1年生存率24.3%,2年生存率7.7%,预期生存期10.34个月。在各种临床因素中,是否存在内脏转移(无内脏转移15.939个月vs.内脏转移9.200个月,P=0.001)、骨转移病变数量(单发18.069个月vs.多发8.934个月,P=0.025)、肿瘤类型(激素依赖型17.331个月vs.激素非依赖型7.533个月,P=0.000)与预后密切相关,Cox回归显示肿瘤类型(激素依赖型或激素非依赖型)是唯一的独立危险因素。结论:股骨上段是转移性肿瘤的好发部位,外科手术在股骨上段转移性肿瘤的治疗过程中发挥着重要作用,在选择外科边界和固定方式的过程中,应充分考虑临床预后因素,才能够最大限度地恢复患者生活质量,并减少并发症的发生率。

Objective：To identify the clinical features and independent predictors of survival in patients with metastases of proximal femur.Methods：In the study,99 patients with proximal femoral metastatic lesions from 2003 to 2011 were analyzed retrospectively.The median age of patients was 56 years old（15-87 years old）,and the most common diagnosis was lung cancer,followed by breast cancer.The overall survival rate after bone metastases was calculated using the Kaplan-Meier method.The prognostic factors were identified by univariate analysis using a Log-rank test and by multivariate analysis using Cox proportional hazards regression models.Results：The 0.5-,1-and 2-year survival rates were 55.7%,24.3% and 7.7%,respectively,with an average survival time of 10.34 months for patients with metastases of proximal femur.In univariate analysis,the number of bone lesions,viscera metastases,and sensitivity to hormone therapy of primary tumor were correlated with prognosis.By multivariate analysis using Cox regression,the dependence to hormone therapy of primary tumor was the only independent prognostic factor.Conclusion：Patients with femoral metastatic lesions can be operated safely and with acceptable complication rates.The prognostic factor analysis will help us to determine the appropriate surgical treatment for proximal femoral metastases.