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背景:目前国内对于乳腺癌脊柱转移的研究主要是手术治疗、放射治疗、化学治疗的疗效,而关于乳腺癌脊柱转移预后影响因素的分析较少。目的:研究乳腺癌脊柱转移手术治疗的预后因素。方法:检索北京大学第三医院骨科2005年1月至2015年9月诊断为乳腺癌脊柱转移的患者,对31例接受脊柱手术并获得完整随访的女性患者进行回顾性分析。分析生存期与患者因素(入院时年龄、诊断乳腺癌到出现脊柱症状的时间间隔、术前Frankel评分、Karnofsky功能状态评分)、肿瘤因素(术前Tomita评分、Tokuhashi评分、术后病理显示ER或PR受体状态)、治疗方式因素(全脊椎切除、术中失血、术前或术后放疗、术前或术后化疗)的关系。结果:患者术后中位生存期为37.0个月(95%CI:29.7~44.3)。单因素生存分析提示Tomita评分(2~3/5~7)、Tokuhashi评分(5~7/8~14)、ER或PR受体状态(阳性/阴性)为潜在预后因素。多因素Cox分析提示Tomita评分、激素受体状态为独立预后因素。结论:Tomita评分、ER或PR受体状态是预测乳腺癌脊柱转移患者预后较具参考价值的指标。
BACKGROUND: At present, the research on spine metastasis of breast cancer in China mainly focuses on the efficacy of surgery, radiotherapy and chemotherapy. However, there are few analyzes on the prognostic factors of the prognosis of spinal metastasis in breast cancer. Objective: To study the prognostic factors of surgical treatment of spinal metastases of breast cancer. Methods: A retrospective analysis was performed on 31 female patients who underwent spine surgery and received complete follow-up after searching the patients diagnosed as spondylosis of breast cancer from January 2005 to September 2015 in Department of Orthopedics, Peking University Third Hospital. Survival and patient factors (age at admission, time to diagnosis of breast cancer until onset of spinal symptoms, preoperative Frankel score, Karnofsky functional status score), tumor factors (preoperative Tomita score, Tokuhashi score, postoperative pathology ER or PR receptor status), treatment modalities (total splenectomy, intraoperative blood loss, preoperative or postoperative radiotherapy, preoperative or postoperative chemotherapy). Results: The median postoperative survival was 37.0 months (95% CI: 29.7-44.3). Univariate survival analysis showed that Tomita score (2--3 / 5-7), Tokuhashi score (5-7 / 8-14) and ER or PR receptor status (positive / negative) were potential prognostic factors. Multivariate Cox analysis suggested that Tomita score and hormone receptor status were independent prognostic factors. Conclusion: The Tomita score, ER or PR receptor status is an index for predicting the prognosis of patients with spine metastasis of breast cancer.