骨盆骨巨细胞瘤临床评分系统的建立及初步临床验证

Construction of clinical score system of pelvis giant cell tumors and primary clinical verification

目的创建骨盆骨巨细胞瘤临床评分系统，回顾性分析多中心骨盆骨巨细胞瘤患者的治疗方式及预后情况以对评分系统进行初步临床验证。方法基于中国骨巨细胞瘤专家组成员的共识，采用专家咨询法自影响骨盆骨巨细胞瘤治疗决策和预后判断的众多因素中筛选出相对重要的一级指标及二级指标，采用层次分析法对二级指标进行分值计算，创建骨盆骨巨细胞瘤临床评分系统。筛选2000年1月至2013年12月六家骨肿瘤治疗中心收治且临床治疗及随访资料完整的骨盆骨巨细胞瘤患者38例，依据评分系统对病例进行评分，分析评分与手术方案、术后功能、临床预后的关系，验证评分系统的准确性。结果骨盆骨巨细胞瘤临床评分系统包含4个一级指标及12个二级指标。①肿瘤部位：非髋臼区（1分）、髋臼区（2分）、同时累及非髋臼区及髋臼区（3分）；②肿瘤大小（在标准正位骨盆X线片上将半骨盆九格均分）：肿瘤大小占1格（1分）、肿瘤大小占2格（2分）、肿瘤大小占2格以上（3分）；③软组织肿块：无软组织肿块（1分）、软组织肿块存在皮质骨一侧（2分）、软组织肿块突破双侧皮质骨（3分）；④骨盆环连续性：骨盆环连续性正常（1分）、非负重区受累（2分）、负重区受累（3分）。评分系统评分合计最低4分，最高12分。多中心38例骨盆骨巨细胞瘤患者评分平均为（7．8±2．6）分，低分组（4-6分）12例、中分组（7-9分）17例，高分组（10-12分）9例。三组间患者的性别、年龄、年龄构成比及随访时间的差异均无统计学意义，而切除方式、重建方式、复发、并发症及MSTS功能评分的差异均有统计学意义，高评分患者接受切除术可能性大，多需要重建，术后局部控制好，但并发症发生的可能性大、术后功能差。结论骨盆骨巨细胞瘤临床评分系统涵盖了影响骨盆骨巨细胞瘤治疗方案和预后判断的主要因素，对于肿瘤切除、重建方式及预后判断具有临床指导价值。

Objective To establish a clinical score system of giant cell tumors （GCT） and verify it by retrospective investigation of the patients with pelvic GCT. Methods Basing on the consensus of experts from giant cell tumor of China, this study established a clinical score system of giant cell tumors using Delphi method and analytic hierarchy process. Important indicators and secondary indicators in the score system were filtrated from some indicators which affect clinical treatments and prognostic factors with Delphi method while the scores for the secondary indicators were calculated with analytic hierarchy process. Thirty-eight patients with GCTs in pelvis were included from Jan 2001 to Jan 2013. According to the scoring system to calculate scores of these clinical cases, this study analyzed the relationship between scores and clinical outcomes, treatments and postoperative function. This retrospective study was used to verify the accuracy of the scoring system. Results There were four important indicators and twelve secondary indicators in this scoring system. The four important indicators included tumor location, tumor size, soft tissue mass and pelvic ring continuity. There were three secondary indicators in each important indicator. For tumor location, the tumor in ilium or ischio-pubic area can get one point, the tumor in acetabulum can get two points, and the tumor involving the above two areas can get three points. For tumor size, in the X-ray film of standard pelvic anteroposterior, nine sub-grid was used for half of the pelvis, the tmnor size in one grid could get one point, the tumor size in two grid could get two points and what exceed two grid could get three points. For soft tissue mass, no soft tissue mass could get one point, the soft mass occurring only on one side could get two points, and the soft mass occurring on two side could get three points. For pelvic ring continuity, the normal continuity could get one point, continuity failure occurring in a non-weight-bearing area could get two points, and continuity failure occurring in a weight-bearing area could get three points. One patient could receive a minimum 4 points and a maximum 12 points. For these thirty-eight patients with an average point 7.8 （4-12）, there are 12 patients scoring 4-6 points, 17 patients scoring 7-9 points, and 9 patients scoring I0-12 points. No obvious difference was found in the three scoring groups including gender, age, age composition, excision method and follow-up time. There were some statistical differences in the three scoring groups including resection method, reconstruction, recurrence, complications and MSTS functional score （χ^2=19.358, P= 0.001; χ^2=16.559, P= 0.002; χ^2=8.015, P=0.018; χ^2=8.782, P= 0.012; F=6.837, P= 0.003）. En-bloc resection, complicated reconstruction, bad local control, complication and bad limb function was likely to appear in high scoring patients. Conclusion Pelvic bone giant cell tumor clinical scoring system covers the main factors affecting the pelvic bone giant cell tumor treatment options and prognosis estimation, there is a guiding role in clinical prognosis and tumor therarap.