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目的:探讨结直肠癌骨转移患者的临床特征及预后。方法:回顾性分析2010年1月—2014年1月收治的116例结直肠癌骨转移患者的临床资料。收集其临床病史、血液指标、影像学及病理学资料、治疗方法及随访资料等。分析直肠癌骨转移的临床特征及预后影响因素,生存率用Kaplan-Meier法计算,单因素分析用Log-rank方法,多因素分析采用Cox回归模型。结果:116例患者以中老年患者居多,单发骨转移51例(44.0%),多发骨转移65例(56.0%),最常见的部位依次为骨盆、胸椎、腰椎、骶椎和肋骨。108例(93.1%)患者合并其他部位转移。从确诊结直肠癌至骨转移的中位时间为15.42个月,从骨转移至首次发生骨相关事件中位时间为2.35个月。骨相关性事件中骨转移灶放疗、严重骨痛和病理性骨折发生率分别为42.2%、22.4%、8.6%。发生骨转移后患者的1、2、3年生存率分别为36.9%、21.4%、12.5%,中位生存时间为11.45个月,单因素分析结果显示:ECOG评分、原发灶大小、ALP水平、CEA水平、是否合并其他部位转移、骨转移后化疗和双膦酸盐治疗与预后相关(均P<0.05);Cox模型多因素分析结果显示:ECOG评分和化疗是预后的独立影响因素(P<0.05)。结论:结直肠癌骨转移患者的预后较差,放疗及双磷酸盐类药物可以为提高生活质量提供帮助,全身化疗可以使患者生存获益。
Objective: To investigate the clinical characteristics and prognosis of patients with colorectal cancer with bone metastasis. Methods: The clinical data of 116 patients with colorectal cancer bone metastasis from January 2010 to January 2014 were retrospectively analyzed. Collect their clinical history, blood parameters, imaging and pathology data, treatment methods and follow-up information. The clinical features and prognostic factors of skeletal metastasis of rectal cancer were analyzed. The survival rates were calculated by Kaplan-Meier method, Log-rank method by univariate analysis and Cox regression model by multivariate analysis. Results: The majority of 116 patients were middle-aged and elderly with single bone metastasis in 51 cases (44.0%) and multiple bone metastases in 65 cases (56.0%). The most common sites were pelvis, thoracic vertebra, lumbar vertebra, sacral vertebra and rib. 108 (93.1%) patients with other parts of the transfer. The median time from the diagnosis of colorectal cancer to bone metastases was 15.42 months, with a median time to bone-related events of 2.35 months. Bone-related events in bone metastases radiotherapy, severe bone pain and pathological fracture rates were 42.2%, 22.4%, 8.6%. The 1-, 2- and 3-year survival rates of patients with bone metastases were 36.9%, 21.4% and 12.5%, respectively. The median survival time was 11.45 months. The results of univariate analysis showed that ECOG score, primary tumor size, ALP level , CEA levels, metastasis of other sites, and postoperative treatment of bone metastases and bisphosphonates were associated with prognosis (all P <0.05). Multivariate analysis of Cox model showed that ECOG score and chemotherapy were independent prognostic factors (P <0.05). Conclusion: The prognosis of patients with colorectal cancer with bone metastasis is poor. Radiotherapy and bisphosphonates can help to improve the quality of life, and systemic chemotherapy can benefit the survival of patients.