治疗前血清 C 反应蛋白是软组织转移患者的重要预后因素。

Pretreatment serum C-reactive protein is a significant prognostic factor in patients with soft tissue metastases.

机构信息

Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.

出版信息

J Orthop Sci. 2021 May;26(3):478-482. doi: 10.1016/j.jos.2020.04.017. Epub 2020 Jun 18.

DOI:10.1016/j.jos.2020.04.017

PMID:32563544

Abstract

BACKGROUND

Soft tissue metastasis is rarer than bone metastasis. Patients with soft tissue metastasis generally have a dismal prognosis. The treatment for metastatic lesions is sometimes difficult, because the prognostic factors of patients with soft tissue metastasis remain unelucidated. Therefore, this study aimed to identify these prognostic factors.

METHODS

Thirty-one patients with soft tissue metastasis were included in the study. We evaluated associations of overall survival with clinical parameters and inflammatory markers using Kaplan-Meier curves and Cox proportional hazards models.

RESULTS

Twelve patients received surgery for soft tissue metastasis, while radiation therapy was performed in six cases. The median overall survival after the detection of soft tissue metastasis was 11 months. Univariate analysis revealed that detection of soft tissue metastasis after the multidisciplinary treatment (P = 0.01); solitary metastasis (P = 0.0003); and pretreatment C-reactive protein (CRP) level < 0.4 mg/dL (P < 0.0001), white blood cell count < 8500 × 10/μL (P = 0.0003), and neutrophil-to-lymphocyte ratio < 5 (P = 0.02) were significant good prognostic factors. Multivariate analysis revealed that a CRP value < 0.4 mg/dL (P = 0.07) and solitary metastasis (P = 0.09) were possible significant predictors of survival. Furthermore, in case of CRP levels <0.4 mg/dL and metastatic tumor resection, patients had a good prognosis; however, when the CRP levels increased to 0.4 mg/dL and above, patients had a poor prognosis, irrespective of tumor resection.

CONCLUSIONS

CRP is potentially useful for determining the indication of radical metastasectomy in soft tissue metastasis.

摘要

背景

软组织转移比骨转移少见。患有软组织转移的患者预后通常较差。转移性病变的治疗有时很困难，因为软组织转移患者的预后因素仍不清楚。因此，本研究旨在确定这些预后因素。

方法

本研究纳入了 31 例软组织转移患者。我们使用 Kaplan-Meier 曲线和 Cox 比例风险模型评估了总生存期与临床参数和炎症标志物之间的关系。

结果

12 例患者接受了软组织转移的手术治疗，6 例患者接受了放射治疗。检测到软组织转移后的中位总生存期为 11 个月。单因素分析显示，多学科治疗后检测到软组织转移（P=0.01）；单发转移（P=0.0003）；以及治疗前 C 反应蛋白（CRP）水平<0.4mg/dL（P<0.0001）、白细胞计数<8500×10/μL（P=0.0003）和中性粒细胞与淋巴细胞比值<5（P=0.02）是显著的良好预后因素。多因素分析显示，CRP 值<0.4mg/dL（P=0.07）和单发转移（P=0.09）可能是生存的预测指标。此外，在 CRP 水平<0.4mg/dL 且转移性肿瘤切除的情况下，患者具有良好的预后；然而，当 CRP 水平升高至 0.4mg/dL 及以上时，无论肿瘤是否切除，患者的预后均较差。