104例结直肠癌骨转移患者的临床特征及预后

Clinical features and prognosis in 104 colorectal cancer patients with bone metastases

目的 探讨结直肠癌骨转移患者的临床特征及预后.方法 回顾性分析104例结直肠癌骨转移患者的临床资料.结果 104例患者中,单发骨转移45例（43.3％）,多发骨转移59例（56.7％）.骨转移最常见的部位为骨盆（46.1％）、胸椎（41.3％）、腰椎（40.4％）、骶椎（29.8％）和肋骨（29.8％）.104例患者中,仅2例患者以骨转移为唯一远处转移灶,102例（98.1％）患者均合并其他部位转移.从确诊结直肠癌至骨转移的中位时间为16个月.从骨转移至首次发生骨相关事件的中位时间为1个月.骨转移灶放疗、严重骨痛、病理性骨折的发生率分别为44.2％、15.4％和9.6％.发生骨转移后患者的中位生存时间为10.0个月,首次发生骨相关事件后患者的中位生存时间为8.5个月.单因素分析中,ECOG评分、化疗和双膦酸盐治疗与结直肠癌骨转移患者的预后有关（均P＜0.05）.多因素分析中,仅ECOG评分和化疗是影响结直肠癌骨转移患者预后的独立因素（均P＜0.05）.结论 结直肠癌骨转移患者的预后较差,化疗和双膦酸盐治疗可能给患者带来生存获益.

Objective To investigate the clinical features and prognosis of bone metastases in colorectal cancer patients. Methods The clinical data of 104 cases of colorectal cancer with bone metastasis were collected and retrospectively analyzed. Results Among all the 104 patients included, 45 （43.3%） patients had multiple bone metastases, and 59 （56.7%） patients had single bone metastasis. Pelvis （46. 1% ） was the most common site, followed by thoracic vertebrae （41.3%）, lumbar vertebrae （40.4%）, sacral vertebrae （29.8%） and ribs （29.8%）. One hundred and two patients （98.1%） were complicated with other organ metastases. The median time from colorectal cancer diagnosis to bone metastasis was 16 months, and the median time from bone metastasis to first skeletal-related events （SREs） was 1 month. The most common skeletal-related events （SREs） were the need for radiotherpy （44.2%）, severe bone pain （ 15.4% ） and pathologic fracture （9. 6% ）. The median survival time of patients with bone metastases was 10.0 months, and 8.5 months for patients with SREs. ECOG score, systemic chemotherapy and bisphosphonate therapy were prognostic factors by univariate analysis （ all P 〈 0.05）. ECOG score and systemic chemotherapy were independent prognostic factors by Cox multivariate analysis. Conclusions Bone metastasis in colorectal cancer patients has a poor prognosis and the use of chemotherapy and bisphosphonates may have a benefit for their survival.