鼻咽癌患者全身骨扫描肋骨99mTc-MDP高摄取灶骨转移的危险因素

Risk Factors of Rib Metastases in Nasopharyngeal Carcinoma Patients with Rib 99mTc-MDP Foci on Whole-body Bone Scans

目的分析鼻咽癌全身骨扫描肋骨99mTc-MDP高摄取灶与肋骨转移率及各临床因素之间的关系,筛选肋骨高摄取灶的骨转移危险因素。方法对312例全身骨扫描出现肋骨99mTc-MDP高摄取灶的鼻咽癌患者进行回顾性分析。采用卡方检验和Logistic回归分析临床因素与肋骨转移的关系。结果312例鼻咽癌患者中,肋骨高摄取灶骨转移率在T分期、颅底骨侵犯、其他骨转移、摄取灶数量、双侧肋骨分布范围、是否合并肺外摄取灶上均存在显著差异(均P<0.01);有效危险因素包括颅底骨侵犯、其他骨转移、双侧肋骨分布范围、是否合并肺外摄取灶(均P<0.05)。176例单纯性肋骨高摄取灶中,肋骨转移率在T分期、颅底骨侵犯、其他骨转移、摄取灶数量、双侧肋骨分布范围均存在显著差异(均P<0.05);仅双侧肋骨分布范围为有效危险因素(P=0.029)。198例单发肋骨高摄取灶中,肋骨转移率在颅底骨侵犯、是否合并肺外摄取灶存在显著差异(均P<0.01);仅是否合并肺外摄取灶为有效危险因素(P=0.000)。566处肋骨高摄取灶中,摄取水平和前后位置为有效危险因素(均P<0.01)。结论鼻咽癌肋骨99mTc-MDP高摄取灶的骨转移危险因素包括颅底骨侵犯、其他骨转移、双侧肋骨分布范围、是否合并肺外摄取灶、摄取水平、前后位置。单侧肋骨的单纯性高摄取灶,以随访为主;而双侧肋骨的多发高摄取灶或单发肋骨高摄取灶合并其他骨摄取灶时,需进一步断层影像检查以排除骨转移。

Objective To investigate the correlation of rib 99mTc-MDP foci on whole-body bone scan with clinical variables and rib metastases in nasopharyngeal carcinoma(NPC)patients,and to screen the risk factors of rib metastases.Methods We retrospectively reviewed 312 NPC patients with rib 99mTc-MDP foci on wholebody bone scan.Chi-square test and logistic regression were performed to evaluate the correlation between clinical variables and rib metastases.Results In all 312 NPC patients,rib metastases were associated with T stage,skull base bone invasion,other bone metastasis,number of rib foci,lateral localization on rib and foci type(P<0.01),and the risk factors of rib metastasis included skull base bone invasion,other bone metastases,lateral localization on rib and foci type(P<0.05).In 176 patients with pure rib foci,rib metastases were closely related to T stage,skull base bone invasion,other bone metastasis,number of rib foci and lateral localization on rib(P<0.05),while only lobar distribution(P=0.029)was the effective risk factor.In 198 patients with single rib focus,rib metastases were affected by skull base bone invasion and foci type(P<0.01),while only foci type(P=0.000)was the effective risk factor.In all 566 rib foci,uptake level and localization on rib were the effective risk factors of rib metastases(P<0.01).Conclusion In NPC patients with rib foci on whole body bone scan,the effective risk factors of rib metastases include skull base bone invasion,other bone metastases,lateral localization on rib,foci type,uptake level and anterior and posterior localization on rib.Follow up should be the main way for the pure rib foci on unilateral ribs.For multiples rib foci on bilateral ribs or single rib focus combined with other bones foci,additional image modalities should be required to exclude bone metastasis.