脊柱肿瘤减压固定术后生存与生存质量相关因素△

Factors related to survival and quality of life secondary to decompression and internal fixation for spinal tumors

摘要:

［目的］ 探讨脊柱肿瘤减压固定术后生存与生存质量的相关因素。［方法］ 回顾性分析 2014 年 7 月—2017 年 7 月， 本院采用单纯减压或减压固定治疗脊柱肿瘤伴脊髓神经损害 153 例患者的临床资料，其中，男 80 例，女 73 例；年龄 17~ 87 岁，平均 （61.10±10.71） 岁。术后持续随访，观察生存患者的 ECOG-PS 评级与 Frankel 指数变化与相关性。采用单项因素比较和 Cox 回归分析生存相关因素。［结果］ 153 例患者随访 3~36 个月。术后 1 个月，78 例患者 （50.98%） ECOG-PS 评分改善，持续时间平均（9.74±0.87）个月。术后 1 个月 76 例（49.67％）Frankel 指数有所改善，其中 71 例 Frankel 指数维持改善持续至术后（10.11±5.17）个月。Spearman 相关分析结果表明各时间点 ECOG-PS 均与 Frankel 指数呈显著负相关（P<0.05）。153 例患者中，术后 12 个月生存 121 例，占 79.08%；死亡 32 例，占 20.12%。生存组的乳腺癌占比、Tokuhashi 修正评分、脊椎外骨转移数量、脊椎受累数量均显著低于死亡组（P<0.05），生存组术前 ECOG-PS 评分和 Frankel 神经功能评级显著优于死亡组 （P<0.05）。Cox 分析表明，术前 Tokuhashi 修正评分 （HR=9.21，P<0.05）、 术前 ECOG-PS 评分 （HR=10.63，P<0.05）、脊椎外骨转移数量（HR=10.45，P<0.05）及脊椎受累数量（HR=2.77，P<0.05）是死亡的独立危险因素。［结论］椎管减压固定术可改善脊柱肿瘤的生存质量。术前 Tokuhashi 修正评分、ECOG-PS 评分、脊椎外骨转移数量和脊椎受累数量是死亡的危险因素。

Abstract:

[Objective] To explore the factors related to survival and quality of life after decompression and internal fixation for spinaltumors. [Methods] From July 2014 to July 2017, 153 patients, including 80 males and 73 females aged from 17 to 87 years with an averageof (61.10±10.71) years, received spinal decompression alone or decompression combined with internal fixation in our hospital for spinal tu-mors complicated with spinal nerve damages. Postoperative follow-up was continued to patient death to observe the change and correlationof ECOG- PS scale and Frankel index of the surviving patients. Univariate comparisons and Cox regression analysis were conducted tosearch the factors to death. [Results] All the 153 patients in survival were followed up for 3~36 months. The ECOG-PS scores significantlyimproved in 78 patients (50.98%) one month after surgery, which was maintained for a mean of (9.74±0.87) months, while the Frankel indexfor neurological function significantly improved in 76 patients (49.67%) at 1 months postoperatively, of them 71 patients had the improve-ment maintained for (10.11±15.17) months after surgery on an average. The Spearman correlation analysis showed that ECOG-PS was sig-nificantly negatively correlated with Frankel index at all corresponding time points (P＜0.05) . Among 153 patients, 121 patients (79.08%)survived, while 32 patients (20.12%) died at 12 months after surgery. In term of univariate comparison between them, the survival grouphad significantly lower proportion of breast cancer, Tokuhashi modified score, the number of extramedullary bone metastases and the num-ber of spinal involved site lower than the death group (P＜0.05) , while the former had significantly better ECOG-PS and Frankel gradesthan the latter (P＜0.05) . As results of Cox analysis, the preoperative Tokuhashi modified score (HR=9.21, P＜0.05) , preoperative ECOGPS score (HR=10.63, P＜0.05) , extraspinal bone metastasis (HR=10.45, P＜0.05) , spinal involved number (HR=2.77, P＜0.05) were the inde-pendent risk factors for death. [Conclusion] Decompression and interna fixation does improve the quality of life of the patients with spinaltumors. The preoperative Tokuhashi modified score, ECOG-PS scale, number of extraspinal bone metastases, and number of spine involved are risk factors for death