食管癌骨转移的临床特征及预后

Clinical features and prognosis in esophageal carcinoma patients with bone metastases

目的探讨食管癌骨转移患者的临床特征及预后。方法选取1981年3月至2012年12月间收治的1 383例接受骨扫描检查的食管癌患者,分析其中131例骨扫描确诊骨转移患者的资料。结果食管癌骨转移的发生率为9.5%,自确诊食管癌至骨转移的中位时间为8.4个月,骨转移后中位生存时间为6.6个月,1年生存率为26.2%。脊柱转移率明显高于其他骨转移部位,其中尤以胸椎转移率最高(23.4%),其次为骨盆49例(20.8%)、肋骨42例(18.2%)、腰椎36例(15.6%)。多发病灶82例(62.6%),单发病灶49例(37.4%)。食管癌不同原发部位间在骨转移部位的分布上无统计学差异,初诊时有淋巴结转移者骨盆转移率高于无淋巴结转移转移者。单因素分析结果显示,骨痛治疗后缓解、骨转移的治疗、骨盆转移与食管癌骨转移患者的预后有关(均P<0.05)。多因素分析结果显示,骨转移的治疗、骨盆转移是食管癌骨转移患者预后的独立因素。结论食管癌骨转移预后较差,骨盆转移影响预后,放化疗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 esophageal carcinoma patients. Methods Data from 1 383 esophageal carcinoma patients with bone scan who were admitted to Cancer Hospital of Chinese Academy of Medical Sciences from March 1981 to December 2012 were collected. There were 131 patients with bone metastases in the current retrospective study.Results Incidence of bone metastases was 9. 5%. Among all the 131 patients included,82（ 62. 6%） patients had muitiple bone metastases,and 49（ 37. 4%） patients had single bone metastases. The median time from esophageal carcinoma diagnosis to bone metastasis was 8. 4 mo. Thoracic vertebrae（ 23. 4%） was the most common site,followed by pelvis（ 20. 8%）,ribs（ 18. 2%） and lumbar vertebrae（ 15. 6%）. Incidence of spinal metastasis was significantly higher than other parts of bone metastases. There was no statistical difference of distribution in parts of bone metastases. In newly diagnosed patients,incidence of pelvic metastasis with lymph node metastasis was higher than those without lymph node metastasis. The median survival time of patients with bone metastases was 6. 6 mo. The 1-yr survival rate was 26. 2%. Effective treatment of pain,therapy of bone metastases and pelvic metastasis were prognostic factors by univariate analysis（ all P 0. 05）. Therapy of bone metastases and pelvic metastasis were independent prognostic factors by Cox multivariate analysis. Conclusion Bone metastasis in esophageal carcinoma patients indicates poor prognosis. Pelvic metastasis is a critical factor affecting prognosis and use of chemotherapy and radiotherapy may have a benefit for their survival.