Surgical Outcomes and Prognostic Factors for Metastatic Spine Hepatocellular Carcinoma
Surgical Outcomes and Prognostic Factors for Metastatic Spine Hepatocellular Carcinoma
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脊柱转移性肝细胞癌的手术结果和预后因素
DOI：
10.1016/j.wneu.2018.10.226
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发表时间：
2019
影响因子：
2
通讯作者：
Dong Jian
中科院分区：
文献类型：
--
作者：
Wang Sheng-Xing;Wang Hou-Lei;Lin Kai-Yuan;Bian Chong;Sun Chi;Dong Jian
背景技术背景：我们评估了脊柱转移性肝细胞癌（HCC）的手术结果，并确定了可能影响脊柱转移性HCC预后的因素。方法：2010年至2017年，72例HCC来源的转移性脊柱肿瘤患者在我科接受治疗。对于每例患者，我们记录了术前和术后视觉模拟量表评分、Frankel分级、围手术期并发症和死亡率。单变量和多变量分析用于探讨可能影响术后生存的一系列因素。结果：平均术后生存期为10.8 ± 5.4个月。Tokuhashi评分为0-8与预期寿命<6个月之间的一致率仅为19.2%。接受切除手术的患者的平均术后生存期为14.7 ± 6.5个月，接受姑息手术的患者的平均生存期为8.5 ± 2.6个月。两组患者的疼痛均显著改善（P < 0.001）。在切除手术组（P = 0.641）或姑息手术组（P = 0.912）中，麻痹没有显著变化。单因素分析显示术前Frankel评分、Tomita评分、Tokuhashi评分、术中出血量、多节段转移和手术方式是影响术后生存时间的独立预后因素。多因素分析显示手术方式、Tomita评分和Tokuhashi评分是影响预后的独立因素。结论：我们的研究结果挑战了先前报道的与Tokuhashi评分相关的预期寿命估计。我们的研究结果表明，切除手术比姑息性手术有更好的临床效果。
BACKGROUND: We evaluated the surgical outcomes of metastatic spine hepatocellular carcinoma (HCC) and determined the factors that might influence the outcomes of metastatic HCC of the spine. METHODS: From 2010 to 2017, 72 patients with HCC-derived metastatic spine tumors were treated in our department. For each patient, we recorded the pre- and postoperative visual analog scale score, Frankel grade, perioperative complications, and mortality. Univariate and multivariate analyses were used to explore a range of factors that might influence postoperative survival. RESULTS: The mean postoperative survival was 10.8 +/- 5.4 months. The concordance rate between a Tokuhashi score of 0-8 and a life expectancy of <6 months was only 19.2%. The mean postoperative survival for patients undergoing excisional surgery was 14.7 +/- 6.5 months, and the mean survival of those receiving palliative surgery was 8.5 +/- 2.6 months. Pain had significantly improved in both patient groups (P < 0.001). Paralysis did not change significantly in the excisional surgery group (P = 0.641) or palliative surgery group (P = 0.912). Univariate analysis showed that the preoperative Frankel score, Tomita score, Tokuhashi score, blood loss, multilevel metastases, and operative type were independent prognostic factors for postoperative survival time. Multivariate analysis showed that operation type was an independent factor for prognosis, just as were the Tomita score and Tokuhashi score. CONCLUSIONS: Our results have challenged previously reported estimates of the life expectancy correlating with the Tokuhashi score. Our results showed that excisional surgery resulted in better clinical outcomes compared with palliative surgery.