脊柱骨巨细胞瘤术后复发的预后因素

摘要

目的 探讨影响活动脊柱骨巨细胞瘤(giant cell tumor of bone,GCTB)术后复发的预后因素.方法 回顾性分析2000年1月至2010年11月治疗85例活动脊柱GCTB患者资料,男27例,女58例;年龄11.0～ 65.0岁,平均(33.0±11.7)岁(中位数33.0岁).其中60例为初次诊断为活动脊柱GCTB患者,25例为由外院转来的活动脊柱GCTB复发患者.术前患者神经功能Frankel分级:A～C级33例,D～E级52例;Jaffe分级:Ⅰ级70例,Ⅱ～Ⅲ级15例.本组患者依据Weinstein-Boriani-Biagini (WBB)分期和Enneking分期制定手术方案,其中EnnekingⅡ期27例,EnnekingⅢ期58例.使用生存分析法确定影响活动脊柱GCTB的独立预后因素.患者术后无复发生存时间(recurrence free survival,RFS)通过KaplanMeier法比较,确定潜在预后因素.将P＜0.1的临床因素纳入多因素分析确定独立预后因素.结果 85例患者均获得随访,随访时间为2～163个月,平均54.7个月(中位数46.0个月).28例患者术后首次出现复发,复发时间为2.0～ 82.0个月,平均19.8个月(中位数13.0个月).单因素分析显示接受全椎节切除术的患者2年、3年和总体复发生存时间均显著提高;使用双磷酸盐治疗患者2年、3年及总体复发生存时间均显著优于未使用双磷酸盐治疗患者;年龄＞ 40岁的患者术后复发生存时间显著低于年龄≤40岁的患者.多因素分析显示手术切除方式、术后双磷酸盐治疗及年龄≤40岁是影响活动脊柱GCTB术后复发的独立预后因素.结论 通过采用en bloc和分块切除的方式进行全椎节切除,同时应用双磷酸盐长期治疗活动脊柱GCTB,可显著降低术后复发率;年龄≤40岁的患者预后较好.%Objective To investigate the prognostic factors of giant cell tumor of bone (GCTB) in the mobile spine.Methods A retrospective analysis of GCTB in mobile spine from January 2000 to November 2010 was conducted.A total of 85 patients were included in the study,including 27 males and 58 females.The average age was 33.0± 11.7 years (range,11-65 years).60 patients admitted in our hospital with primary GCTB,and 25 patients with recurrent GCTB which was operated in other hospitals.33 patients were admitted with a Frankle score of A-C grade,and 52 patients were D-E grade.70 cases were classified as stage Ⅰ,and 15 cases as stage Ⅱ-Ⅲ in Jaffe pathologic grading system.The surgical strategies were determined according to Weinstein-Boriani-Biagini (WBB) and Enneking grading system.There were 27 cases classified as Enneking stage Ⅱ and 58 cases as stage Ⅲ.The prognostic factors were analyzed by using the method of survival analysis.Recurrence free survival (RFS) was defined as the interval between the date of surgery and the date of recurrence.The postoperative RFS rate was estimated by the Kaplan-Meier method.Factors with P values ＜ 0.1 were subjected to multivariate analysis for RFS by proportional hazard analysis.Results The mean follow-up period was 54.7 months (median 46.0 months,range 2-163 months).28 patients developed recurrence.The mean recurrent interval was 19.8 months (median 13.0 months,range 2.0-82.0 months).Univariate analysis showed that patients who received total spondylectomy had significantly better 2-year,3-year and overall RFS.Patients received bisphosphonate therapies were found to share better 2 year,5 year and overall RFS; RFS by age was significantly decreased in patients older than 40 years.The multivariate analysis suggested that total spondylectomy,bisphosphonate treatment and age less than 40 years were independent favorable prognostic factors.Conclusion The removal of the entire osseous compartment either by en bloc or piecemeal method in combination with the long-term usage of bisphosphonate could significantly reduce the recurrence rate of GCTB of the mobile spine.Age less than 40 years is a faverable prognostic factor for GCTB in the mobile spine.