Clinical Features Of 98 Patients With Metastatic Carcinoma Of Vertebral Body Prognostic Factors After Radiotherapy

Objective To investigate the clinical characteristics of patients with malignant tumor with vertebral metastatic carcinoma and the prognostic factors after radiotherapy.Methods A retrospective study from July 2013 to December 2016 in 105 Hospital of the People's Liberation Army oncology and interventional treatment of 98 cases of patients with vertebral metastases carcinoma,based on clinical and follow-up data of patients,using a unified questionnaire to extract relevant content,including gender,age,location and number of vertebral lesions,primary site,the pathological type,without visceral metastasis,found vertebral metastasis distance first treatment time,without pathological fracture or dysfunction,radiotherapy dose,without chemotherapy or targeted therapy,at the end of the follow-up time and survival time data.By the visual analogue scale(Visual analogue scale,VAS),physical condition score(Karnofsky performance,score,KPS)to evaluate each patient's pain and physical condition;assessment of patient age and body condition score and there is no chemotherapy or targeted therapy and other factors on the survival of patients with the effect of using Kaplan-Meier method;using Cox proportional the risk analysis model of survival in patients with age,KPS score,non-squamous cell carcinoma or non-adenocarcinoma of other pathological types,visceral metastasis factors.Result 1.The age of 98 patients with metastatic carcinoma of vertebral body was 45-70 years old,accounting for more than 70%,which was basically the same as the peak age of malignant tumor.2.Among the 98 patients,the first diagnosis of vertebral metastasis was 6 months for the first time diagnosis of primary,and 47 cases(48%).The single vertebral body metastases were less(19.7%),and most of them had 2 or more vertebral metastases(80.6%).The number of metastatic <3,48 cases(49%),the number of vertebral metastasis is more than 3,50 cases(51%),There were 15 of the most vertebral metastases.The common sites for thoracic vertebral metastases(57),lumbar(57);associated with visceral metastasis in 29 cases(29.6%),with 1 visceral metastases in 22 cases,with at least 2 visceral metastases in 7 cases,common visceral metastasis of pulmonary metastasis(13 cases)and liver metastasis(13 cases).3.The primary site of vertebral metastasis in lung(58.2%),the most common pathological type and the proportion of low order for 53 cases of adenocarcinoma(54.1%),20 cases of squamous cell carcinoma(20.4%),other 15 cases(15.3%)were hepatocellular carcinoma and small cell carcinoma,There were no pathology in 10 cases(10.2%).98 cases of card type score,80 points accounted for half of the total(50%),cassette score of 70 or less in 36 cases(36.7%),>70 62 cases(63.3%).4.The dose of radiotherapy in 98 patients was between 2500 c Gy-4000 c Gy,of which 64 cases(65.3%)were 3000 c Gy,8 were 2500 c Gy(8.1%),and 26 cases(26.5%)were 4000 c Gy.73 patients received systemic chemotherapy or targeted therapy,of which 27 patients with concurrent chemotherapy / targeted therapy,46 continuous chemotherapy / targeted therapy.5.Pain is the most frequent Skeletal related event(SREs)of vertebral metastases,and there are almost all levels of pain(94.9%)in the patients.A case of pathological fracture or dysfunction is not uncommon(40.8%),and is significantly associated with the survival of the patient.6.The survival period of 98 patients with vertebral metastases was 0-42 months,the median survival period was 8 months,the 1 year survival rate was 32.65%,the 2 year survival rate was 19.21%,and the 3 year survival rate was 6.15%.7.Log-rank univariate analysis showed that age more than 60 years old,KPS score below 70,non-adenocarcinoma or non-squamous cell carcinoma of the other pathological types,visceral metastasis and no chemotherapy or targeted therapy for vertebral metastasis were significant prognostic factors for patients with vertebral metastatic carcinoma,P value was <0.05.There was no statistically significant difference in the survival time of sex,vertebral lesion location and number,primary site,vertebral metastasis between the first visit time,whether there were pathological fracture or dysfunction,radiotherapy dose and pain score.The P value was >0.05.8.Multivariate Cox regression analysis showed that age greater than 60 years(relative risk,RR)= 1.758,95%CI:1.119-2.762),KPS score less than or equal to 70(RR= 0.628,95%CI:0.402-0.983)and other pathological types of non-adenocarcinoma or non-squamous cell carcinoma(RR= 1.398,95%CI:1.074-1.821),visceral metastases(RR= 1.941.95%CI:1.199-3.143)independent prognostic factors in patients with metastatic carcinoma of vertebral body(P<0.05).Conclusion 1.98 cases of malignant tumor patients with vertebral metastases mostly in the 45-70 years of age;single vertebral metastasis is rare,almost all more than 2 vertebral metastasis;thoracic vertebra is the most common site of vertebral metastasis;lung and liver are common visceral metastases;proportion of primary tumors is the highest in the lung;the highest proportion for vertebral metastatic is adenocarcinoma;the most common symptoms of cancer pain;pathological fractures and dysfunction rate is higher,but the incidence is not correlated with the survival time of patients;the dose of radiotherapy for metastatic carcinoma of the vertebral body is between 2500 c Gy-4000 c Gy,the recommended dose of radiotherapy for metastatic carcinoma of the vertebral body should not be less than 3000 c Gy.2.The age,pathological type,card type score and visceral metastasis have an important influence on the prognosis of patients with metastatic carcinoma of vertebral body,and comprehensive treatment should be taken.Receiving systematic chemotherapy or targeting therapy improves the patient's survival to a certain extent.