乳腺癌脊柱转移手术治疗预后因素分析

Prognostic factors of surgical treatment for spinal metastases of breast cancer

背景:目前国内对于乳腺癌脊柱转移的研究主要是手术治疗、放射治疗、化学治疗的疗效,而关于乳腺癌脊柱转移预后影响因素的分析较少。目的:研究乳腺癌脊柱转移手术治疗的预后因素。方法:检索北京大学第三医院骨科2005年1月至2015年9月诊断为乳腺癌脊柱转移的患者,对31例接受脊柱手术并获得完整随访的女性患者进行回顾性分析。分析生存期与患者因素(入院时年龄、诊断乳腺癌到出现脊柱症状的时间间隔、术前Frankel评分、Karnofsky功能状态评分)、肿瘤因素(术前Tomita评分、Tokuhashi评分、术后病理显示ER或PR受体状态)、治疗方式因素(全脊椎切除、术中失血、术前或术后放疗、术前或术后化疗)的关系。结果:患者术后中位生存期为37.0个月(95%CI:29.7~44.3)。单因素生存分析提示Tomita评分(2~3/5~7)、Tokuhashi评分(5~7/8~14)、ER或PR受体状态(阳性/阴性)为潜在预后因素。多因素Cox分析提示Tomita评分、激素受体状态为独立预后因素。结论:Tomita评分、ER或PR受体状态是预测乳腺癌脊柱转移患者预后较具参考价值的指标。

Background：The study on spinal metastases of breast diseases focuses on the clinical effect of surgery, radiotherapy and chemotherapy, but there are few studies on the prognosis of the spine metastases. Objective： To explore the prognostic factors of surgical treatment for spinal metastases of breast cancer. Methods：The patients diagnosed as spinal metastases of breast cancer clinically and pathologically from January 2005 to September 2015 in our hospital were retrospectively analyzed. Of them, 31 patients were followed up after surgical treatment and enrolled in this study. Their survival time, patient factors （age, interval between diagnosis of breast cancer and symptom of spine, preoperative Frankel score, Karnofsky performance score）, tumor factors （preoperative Tomita score, Tokuhashi score, ER or PR status）, and treatment factors （total en bloc spondylectomy, intraoperative blood loss, radiotherapy, chemotherapy） were detected. Results： The postoperative median survival time was 37.0 months （95%CI：29.7-44.3）. Univariate survival analysis indicated that Tomita score, Tokuhashi score and receptor status had significant association with survival time. However, multivariate Cox regression indicated that only Tomita score and receptor （ER or PR） status were independent prognostic factors. Conclusions：Tomita score and receptor （ER or PR） status can well predict the postoperative survival time of patients undergoing spinal surgery for metastatic breast disease.