结肠直肠癌单纯骨转移的临床特征与生存分析(附47例报告)

Clinical features and survival analysis of colorectal cancer patients with solitary bone metastases:47 cases report

目的:探讨结肠直肠癌单纯骨转移的临床特征及影响预后的相关因素。方法:2006年11月至2013年10月本院收治的47例结肠直肠癌单纯骨转移病人为研究对象,对其临床资料进行回顾性分析。结果:47例单纯骨转移病人有30例(63.8%)为单处骨转移,17例(36.2%)为多处骨转移。共70处骨转移,其中骨盆26处(37.1%)、脊柱23处(32.9%)、四肢骨12处(17.1%)、胸部骨6处(8.6%)、颅骨3处(4.3%)。多处骨转移组比单处骨转移组的低分化肠癌比例高,分别为66.7%和28.0%(P=0.036)。发生骨转移后病人的中位总生存时间为29.1个月。单因素分析发现,多处骨转移,伴有原发灶神经侵犯,诊断骨转移时癌胚抗原阳性、碱性磷酸酶(alkaline phosphatase,ALP)升高对结肠直肠癌单纯骨转移的预后有影响(P<0.05)。COX多因素分析中神经侵犯和诊断骨转移时ALP升高是影响结肠直肠癌单纯骨转移病人预后的独立危险因素(P<0.05)。结论:结肠直肠癌单纯骨转移病人中原发灶伴神经侵犯或ALP≥130U/L提示预后差。

Objective To investigate the clinical features and prognosis of patients with solitary bone metastases from the colorectal cancer. Methods Retrospective analysis was underwent on the clinical data of 47 colorectal cancer patients with solitary bone metastases in Shanghai Cancer Center Fudan University from November 2006 to October 2013. Results Thirty （63.8%） in 47 patients had single bone metastases and 17 （36.2%） patients multiple bone metastases. A total of 70 bone metastases sites were found in 47 patients. Pelvis （n=26, 37.1%） was the most common site, followed by vertebrae （n=23, 32.9%）, bones of the extremities （n=12, 17.1%）, thoracic bones （n=6, 8.6%） and skull （n=3, 4.3%）. Poorly differentiated carcinoma was more common in multiple bone metastases （66.7%） than that in single bone metastases （28.0%） （P= 0.036）. The median overall survival after diagnosis of bone metastases was 29.1 months. Muhiple bone metastases, per- ineural invasion, positive value of CEA and elevation of alkaline phosphatase （ALP） when diagnozed as bone metastases were the worse factors of prognosis by uuivariate analysis （P〈0.05）. The level of ALP during the diagnosis of bone metastases and perineural invasion were both independent prognostic factors by Cox multivariate analysis （P〈0.05）. Conclusions It could be indicated as poor prognosis in colorectal cancer patients when colorectal cancer with solitary bone metastases combined with perineural invasion or ALP≥ 130 U/L.