86例肺癌脊柱转移患者的治疗效果及预后分析

Analysis on the curative effect and prognosis of 86 cases of lung cancer patients with spinal metastasis

目的总结86例肺癌脊柱转移患者的临床治疗,探讨其治疗效果及预后的影响因素。方法回顾性分析首次确诊的86例肺癌合并脊柱转移患者的临床和随访资料,根据治疗方式不同分为手术组(n=27)和保守治疗组(n=59),比较两组患者治疗前后视觉疼痛评分(VAS)、卡氏日常状态评分(KPS)及Frankel分级,采用Kaplan-Meier法绘制生存曲线,采用Cox逐步回归分析法分析肺癌脊柱转移患者的影响因素。结果治疗后手术组VAS评分低于保守治疗组(P﹤0.05),KPS评分高于保守治疗组(P﹤0.05),治疗后两组患者Frankel分级均有改善,手术组效果更优(P﹤0.05)。86例患者中位生存时间为6个月(95%CI:5.639~6.361)。Cox逐步回归分析结果显示KPS评分、脊柱转移灶数量和是否有其他脏器转移是影响患者预后的独立因素。结论肺癌脊柱转移癌的手术治疗在减轻疼痛、提高生活质量和改善神经功能方面效果显著,对患者预后无影响,针对此类患者全面正确地评估患者手术指征十分重要。

Objective To summarize the clinical profile of 86 cases of lung cancer patients with spinal metastases, to explore the curative effect and prognostic factors. Method The clinical and follow-up data of 86 patients with newly diagnosed lung cancer with spinal metastases were divided as surgery group（n=27） and conservative therapy group（n=59）according to respective treatment administered, of which the visual analogue score（VAS） of pain, Karnofsky performance score（KPS）, and Frankel classification before and after treatment were compared, and the survival curve was plotted using Kaplan-Meier, and Cox stepwise regression analysis was performed to analyze the factors influencing the spinal metastases in these patients. Result The VAS score of the surgery group was significantly lower than that of the conservative treatment group（P〈0.05）. The KPS score was significantly higher in surgery group than that of the conservative group（P〈0.05）. Frankel classifications were improved in both groups after treatment, while greater improvement was observed in surgery group（P〈0.05）. The median survival time was 6 months（95%CI： 5.639-6.361） for the 86 cases. COX stepwise regression analysis showed that the KPS score, the number of spinal metastases and the presence of metastases in other organs were independent factors influencing the prognosis. Conclusion Surgical treatment of lung cancer with spinal metastases is effective in reducing pain, improving quality of life and neurological function, with no negative effect on the prognosis of patients. It is very important to comprehensively and correctly evaluate the indications of surgical operation.