Cereceda Luis E, Flechon Aude, Droz Jean-Pierre
Oncology Service, Hospital de La Fuerza Aerea de Chile, Santiago, Chile.
Clin Prostate Cancer. 2003 Jun;2(1):34-40. doi: 10.3816/cgc.2003.n.010.
The objectives of this study were to define clinical problems and treatment strategies in vertebral metastases of prostate cancer. The clinical files of 634 patients with prostate cancer seen in a comprehensive cancer center during a 4-year period were retrospectively reviewed. One hundred nineteen patients (18.8%) had 212 significant episodes of osseous spinal metastases. Pain was nearly universal (93%), and motor and bladder impairment occurred in 25% and 3.1% of patients, respectively. Bone scan and magnetic resonance imaging (MRI) were performed in 197 and 64 episodes, respectively. Fifteen episodes of spinal cord compression were treated surgically. Other treatments included hormonal therapy (163 episodes), chemotherapy (70 episodes), and radiation therapy (103 episodes). Osteolytic lesions were observed alone and in combination with osteoblastic pattern in 18% and 26% of episodes, respectively. Bone scan was the most effective screening procedure of vertebral involvement, and MRI effectively showed epidural involvement. Overall treatment led to improvements in pain and motor impairment in 77% and 50% of patients, respectively. However, clinical episodes were recurrent (1.78 episodes per patient; range, 1-8). Median survival after vertebral metastasis episode was 14 months compared with only 4 months after surgery for spinal cord compression. Vertebral metastases strongly alter quality of life in patients with prostate cancer. Pain and neurologic complications are the major problems. Careful early screening with bone scan and MRI may help to define better treatment strategy. However, further prospective studies of clinical management are needed to determine the optimal timing of radiation therapy, medical treatments, and surgery.
本研究的目的是明确前列腺癌椎体转移的临床问题及治疗策略。对一家综合癌症中心在4年期间诊治的634例前列腺癌患者的临床资料进行了回顾性分析。119例患者（18.8%）发生了212次严重的脊柱骨转移。疼痛几乎普遍存在（93%），运动和膀胱功能障碍分别发生在25%和3.1%的患者中。分别对197次和64次转移进行了骨扫描和磁共振成像（MRI）检查。对15次脊髓压迫进行了手术治疗。其他治疗包括激素治疗（163次）、化疗（70次）和放疗（103次）。溶骨性病变单独出现及与成骨性病变合并出现的情况分别占18%和26%。骨扫描是筛查椎体受累最有效的方法，MRI能有效显示硬膜外受累情况。总体治疗使77%的患者疼痛得到改善，50%的患者运动功能障碍得到改善。然而，临床症状会复发（每位患者1.78次；范围为1 - 8次）。椎体转移发作后的中位生存期为14个月，而脊髓压迫手术后仅为4个月。椎体转移严重影响前列腺癌患者的生活质量。疼痛和神经并发症是主要问题。通过骨扫描和MRI进行仔细的早期筛查可能有助于制定更好的治疗策略。然而，需要进一步开展临床管理的前瞻性研究，以确定放疗、药物治疗和手术的最佳时机。
