姑息性手术治疗脊柱转移瘤的疗效观察和影响因素分析

Curative effect and influencing factors of palliative surgery for spinal metastasis

目的:探讨影响脊柱转移瘤患者姑息性手术疗效的相关因素,为提高临床外科手术治疗脊柱转移瘤的疗效提供参考。方法:回顾性分析2017年5月至2020年12月广州医科大学附属第三医院脊柱外科采用经皮椎体成形术或姑息减压手术治疗的脊柱转移瘤患者共56例。通过病历和电话随访收集每位患者的病历资料、术后治疗情况及愈后。满足术后疼痛缓解≥3个月定义为疗效良好,否则定义为疗效不佳,若3个月内死亡亦定义为疗效不佳。采用单因素及多因素的logistic回归分析筛选PVP术和减压手术疗效的独立影响因素。结果:56例患者中成功随访52例,随访结束时41例患者死亡,其中10例3月内死亡,33例1年内死亡。PVP术治疗的患者,23例(67%)满足疗效良好。减压术治疗的患者,13例(72%)满足疗效良好。单因素分析显示:术前营养状态、术前生活状态、靶向药物治疗、化疗期间脊柱转移、脊柱外骨转移、内脏转移、术后放疗、Frankel分级对手术疗效存在影响(均P<0.05)。多因素分析结果为:术前营养不良、术前生活状态不佳、原发灶控制不佳、术后无放疗、神经功能差是手术治疗疗效不佳的独立危险因素(均P<0.05)。结论:PVP和姑息减压手术能使大多数的患者直接获益。手术疗效与原发灶器官和位置无明显相关性,原发灶的控制情况、术前营养状况、生活状态、术后是否继续接受放疗、术前的神经功能损伤情况是影响手术疗效的独立相关因素。

Objective:To investigate the related factors that affect the efficacy of palliative surgery in patients with spinal metastasis,and to provide references for improving clinical surgery of spinal metastasis.Methods:The clinical data of 56 patients with spinal metastasis treated by percutaneous vertebroplasty(PVP)or palliative decompression surgery in the Department of Spinal Surgery,the Third Affiliated Hospital of Guangzhou Medical University between May 2017 and December 2020 were retrospectively analyzed.The medical history,postoperative treatment and prognosis of each patient were collected through medical records and telephone follow⁃up.Postoperative pain relief≥3 months was defined as good efficacy,otherwise it was defined as poor efficacy,and death within 3 months was also defined as poor efficacy.Univariate and multivariate logistic regression analyses were used to screen the independent influencing factors for the efficacy of PVP and decompression surgery.Results:Fifty⁃two of the 56 patients were successfully followed up.At the end of the follow⁃up,41 patients died,including 10 died within 3 months,and 33 died within 1 year.Among the patients treated with PVP and decompression surgery,there were 23(67%)and 13(72%)of good efficacy,respectively.Univariate analysis showed that preoperative nutritional status,preoperative living status,targeted drug therapy,spinal metastasis during chemotherapy,extraspinal bone metastasis,visceral metastasis,postoperative radiotherapy and Frankel grade influenced the efficacy(all P<0.05).Multivariate analysis showed that preoperative malnutrition,poor preoperative living status,poor control of primary lesions,no postoperative radiotherapy,and poor neurological function were independent risk factors for poor surgical efficacy(all P<0.05).Conclusion:PVP and palliative decompression surgery may benefit most patients directly.There is no significant correlation between the surgical efficacy and the organ or location of the primary tumor.The control of the primary tumor,preoperative nutritional status,living status,postoperative radiotherapy,and preoperative neurological damage were the independent correlative factors that influence the efficacy of surgery.