Du Zhiye, Guo Wei, Yang Rongli, Tang Xiaodong, Ji Tao, Li Dasen
Department of Musculoskeletal Tumor Centre, Peking University &People's Hospital, Beijing, China.
PLoS One. 2016 Dec 19;11(12):e0168313. doi: 10.1371/journal.pone.0168313. eCollection 2016.
To investigate the impact of surgery on local control and quality of life for patients with sacral metastases and to determine whether the complications of surgery were acceptable.
Curettage for metastatic lesions of the sacrum was performed in 154 patients with obvious sacral nerve compression symptoms between July 1997 and July 2014. Potential risk factors were evaluated in univariate analysis for associations with local control; multivariate conditional logistic regression was used to identify the combined effects. Complications were recorded. The pre- and postoperative visual analogue scale of pain, Eastern Cooperative Oncology Group (ECOG) scores, and quality of life scores were collected to evaluate the impact of surgery.
The cumulative survival rates were 71.8%, 41.1%, and 22.5% and the local control rates were 95.4%, 90.9%, and 79.4% at 6, 12, and 24 months, respectively. Tumors with rapid growth, the lack of preoperative radiotherapy, and application of aortic balloon occlusion were significantly associated with good local control. There were 29 (18.8%) complications related to surgery. The mean pain scores were 7.04 preoperatively, 1.66 at 1 month postoperatively (p = 0.003), and 1.51 at 3 months postoperatively (p = 0.002). The mean ECOG scores were 2.82 preoperatively and 1.47 3 months postoperatively (p < 0.001). There were significant improvements from preoperatively to 3 months postoperatively in global health status (43.3 vs. 52.1), pain (62.0 vs. 33.2), and constipation (51.4 vs. 30.3) (p < 0.001).
Surgery for sacral metastasis is effective to palliate pain rapidly and improve constipation and quality of life and has a low rate of complications.
探讨手术对骶骨转移瘤患者局部控制及生活质量的影响，并确定手术并发症是否可接受。
1997年7月至2014年7月期间，对154例有明显骶神经压迫症状的患者进行了骶骨转移瘤病灶刮除术。在单因素分析中评估潜在风险因素与局部控制的相关性；采用多因素条件逻辑回归确定联合效应。记录并发症情况。收集术前和术后的视觉模拟疼痛评分、东部肿瘤协作组（ECOG）评分及生活质量评分，以评估手术的影响。
6个月、12个月和24个月时的累积生存率分别为71.8%、41.1%和22.5%，局部控制率分别为95.4%、90.9%和79.4%。肿瘤生长迅速、术前未行放疗及应用主动脉球囊阻断与良好的局部控制显著相关。有29例（18.8%）手术相关并发症。术前平均疼痛评分为7.04，术后1个月为1.66（p = 0.003），术后3个月为1.51（p = 0.002）。术前平均ECOG评分为2.82，术后3个月为1.47（p < 0.001）。从术前到术后3个月，总体健康状况（43.3对52.1）、疼痛（62.0对33.2）和便秘（51.4对30.3）均有显著改善（p < 0.001）。
骶骨转移瘤手术能有效快速缓解疼痛、改善便秘及生活质量，且并发症发生率低。
