The Study Of Correlation Of The Between Operative Treatment And Influencing Factors For Thoracic And Lumbar Metastatic Tumors

Objective：To investigate the effect of resection for thoracic and lumbar metastatictumors and the relationship between the treatment result and influential factors.Methods: From September2003to August2010,there were40cases who underwentsurgical treatment because of thoracic and lumbar metastatic tumors in the department oforthopedics of the Fourth Affiliated Hospital of SuZhou University. We adoptedquestionnaire investigating way, telephone and out-patient callback to collect the data ofevaluating curative effect. There were17males and23females with the average age58years old(range,27～74).The primary cancer sites were the breast, prostate, colon, lung,liver, esophagus, kidney, bladder and unidentified primary cancer in4.There were24in thethoracic spine and16in the lumbar spine. The Tokuhashi system: total score0～8in7cases, total score9～11in25cases，total score12～15in8cases. The surgical proceduresincluded vertebroplasty, tumor resection and decompression, artificial vertebra replacement,bone cement stuffiness and inter fixation which based on Tokuhashi score, location oflesions and neurological symptoms. According to Japanses Orthopaedics Assocation(JOA),Visual analogue scale(VAS), the system of Frankel and the system of EasternCooperative Oncology Group performance status（ECOG）,the preoperative and thepostoperative clinical effect of all patients were evaluated respectively. Statisticalanalytical methods (Paired-samples t tests, Chi-square test, Spearman rank correlationanalysis, Logistic regression analysis and Survival analysis) were performed to study therelation between the influencing factors and the treatment outcome of the thoracic andlumbar metastatic tumors.Results：1、The VAS pain scores had declined after operation from (7.0±2.0) to (2.0±1.2)(t=2.17，P<0.05).2、According to the functional grade of Frankel:28cases（90.32%） improved1～3grade after surgery in31cases suffered from spinal cord and(or) nerve compromise.3、According to the system of the ECOG performance status:36patients(90%)improved1～2grade after surgery.4、3months after operation JOA score improved significantly, and the differences weresignificant(P<0.05).According to the assessment scale proposed by Even Lin Liefa, thetotal excellent and good rate of33cases were82.50%.5、Analysis of surgical related factors: Excellent and good rates for clinical results inthe group of the good of general condition and the poor of general condition were93.10％and54.55%respectively. As blood loss in surgery, excellent and good rates for clinicalresults in the group of <1500ml and in the group of≥1500ml were91.43%and20%respectively. Excellent and good rates for clinical results in the group of existingextraspinal bone metastases foci and in the group of non-existing extraspinal bonemetastases foci were37.50％and93.75％respectively. As predicted survival periodbefore surgery, excellent and good rates for clinical results in the group of long and in thegroup of short were93.55％and44.44％respectively. As the Frankel grade before surgery,excellent and good rates for clinical results in the group of high and in the group of lowwere91.18％and33.33％respectively. As Tokuhashi score before surgery, excellent andgood rates for clinical results in the group of high and in the group of low were97.97％and14.29%respectively. The differences between each factor group and clinical resultswere significant (P＜0．05). Age, sex, BMI and metastases to the major internal organs hadno significant effects on clinical results (P＞0．05). As affected factors were analyzed bymultivariate Logistic regression analysis, blood loss in surgery，the Frankel grade beforesurgery and bone metastases were independently dangerous factors affected clinical results,but predicted survival period and Tokuhashi score before surgery were advantageousfactors affected clinical results.6、There were correlation between the Frankel grade and the ECOG grade preoperative and postoperative.7、The postoperative survival rates at6months,1year and2years were97.2%、87.4%and31.9%respectively.6cases had vertebral bone cement leakage, and none resulted insevere complications.8、Analysis of the degree of the satisfaction to the curative effect of surgery:72%ofthe all patients felt satisfaction,18%of the all patients were in the middle and10%of theall patients felt common.Conclusion：1、Decompression to the spinal cord and stabilizing and reconstructingthe spine are key to obtaining satisfactory results in the management of thoracic andlumbar metastatic tumors.2、General condition before surgery, low of blood loss in surgery, extraspinal bonemetastases foci before surgery, predicted survival period, the Frankel grade beforesurgery,the Tokuhashi score before surgery are main factors affecting clinical results.Blood loss in surgery, the Frankel grade before surgery and extraspinal bone metastasesfoci were independently dangerous factors affected clinical results, but predicted survivalperiod and Tokuhashi score before surgery were advantageous factors affected clinicalresults. Avoiding the unfavorable influences of the factors will improve the clinical results.