CAJ | 학술논문

目的评价Tokuhashi外科评分、Tokuhashi外科修正评分和Tomita外科评分对脊柱转移瘤患者治疗选择与预后预测的临床价值.方法回顾性分析104例经病理学确诊并获得随访的硬膜外脊柱转移瘤手术患者的临床和随访资料.绘制Tokuhashi外科评分、Tokuhashi外科修正评分和Tomita外科评分在预期寿命为3个月内死亡、6个月内死亡、12个月内死亡以及24个月内死亡的受试者工作特征(ROC)曲线,计算曲线下面积(AUC),比较它们预测患者生存时间的准确性.绘制Kaplan-Meier生存曲线,计算3种评分系统中各得分段患者的术后中位生存时间,并与预计生存时间进行比较.对3种评分系统的结果与患者的生存时间进行Spearman相关分析.结果全组患者的中位生存时间为8.0个月.ROC曲线分析结果显示,Tokuhashi外科评分、Tokuhashi外科修正评分和Tomita外科评分的准确性差异无统计学意义(P＞0.05).在各时间段内,Tokuhashi外科评分的AUG值均较小,诊断准确性低.Tokuhashi外科修正评分在12个月内死亡和24个月内死亡组的AUG值均＞0.7,诊断准确性较高.Tomita外科评分在6个月内死亡和24个月内死亡组的AUC值较大,诊断准确率较高.Kaplan-Meier生存分析结果显示,3种评分系统中各得分段患者的术后中位生存时间与预计生存时间并不完全相符.Tokuhashi外科评分和Tokuhashi外科修正评分的结果与患者的生存时间呈正相关(γ=0.414,P=0.0001和γ=0.426,P=0.0001),而Tomita外科评分的结果与患者的生存时间呈负相关(γ=-0.521,P=0.001).结论 3种评分系统的结果与硬膜外脊柱转移瘤患者的预后密切相关.如将Tokuhashi外科修正评分和Tomita外科评分结合使用,可能可以更好地预测硬膜外脊柱转移瘤患者术后生存情况,并用来指导手术的选择.
목적 평개Tokuhashi외과평분、Tokuhashi외과수정평분화Tomita외과평분대척주전이류환자치료선택여예후예측적림상개치.방법 회고성분석104례경병이학학진병획득수방적경막외척주전이류수술환자적림상화수방자료.회제Tokuhashi외과평분、Tokuhashi외과수정평분화Tomita외과평분재예기수명위3개월내사망、6개월내사망、12개월내사망이급24개월내사망적수시자공작특정(ROC)곡선,계산곡선하면적(AUC),비교타문예측환자생존시간적준학성.회제Kaplan-Meier생존곡선,계산3충평분계통중각득분단환자적술후중위생존시간,병여예계생존시간진행비교.대3충평분계통적결과여환자적생존시간진행Spearman상관분석.결과 전조환자적중위생존시간위8.0개월.ROC곡선분석결과현시,Tokuhashi외과평분、Tokuhashi외과수정평분화Tomita외과평분적준학성차이무통계학의의(P＞0.05).재각시간단내,Tokuhashi외과평분적AUG치균교소,진단준학성저.Tokuhashi외과수정평분재12개월내사망화24개월내사망조적AUG치균＞0.7,진단준학성교고.Tomita외과평분재6개월내사망화24개월내사망조적AUC치교대,진단준학솔교고.Kaplan-Meier생존분석결과현시,3충평분계통중각득분단환자적술후중위생존시간여예계생존시간병불완전상부.Tokuhashi외과평분화Tokuhashi외과수정평분적결과여환자적생존시간정정상관(γ=0.414,P=0.0001화γ=0.426,P=0.0001),이Tomita외과평분적결과여환자적생존시간정부상관(γ=-0.521,P=0.001).결론 3충평분계통적결과여경막외척주전이류환자적예후밀절상관.여장Tokuhashi외과수정평분화Tomita외과평분결합사용,가능가이경호지예측경막외척주전이류환자술후생존정황,병용래지도수술적선택.
Objective To evaluate the predictive values of Tokuhashi score, revised Tokuhashi score and Tomita score systems for life expectancy and treatment options in patients with spinal metastasis.Methods From February 1996 to January 2009, spinal operations in 104 cases with spinal metastasis were performed in our hospital. There were 65 males and 39 females, with an average of 53.4 years (median52.5 years). To calculate AUC (area under the curve) values of Receiver Operating Characteristic (ROC)curves of three scores, and to analyze the accuracy of prediction of life expectancy. To compare the actual survival time with the expected survival time of the three scores by Kaplan-Meier method.Spearman correlation analysis was performed between the survival time and three scoring systems. Results All cases were followed-up with an average duration of 10. 9 months, and 77 patients died. AUC analysis of ROC curves showed that the difference of the accuracy of the three scores was not significant. AUC in all groups of Tokuhashi Score was low, with a poor diagnostic accuracy. In the "died within 3 months" and "died within 6 months" groups of revised Tokuhashi score, the accuracy was low, while high in the other two groups. The AUC values of Tomita score in "died within 6 months" and "died within 24 months" were high, with a great diagnostic accuracy while the other two groups were low with a low diagnostic accuracy. Kaplan-Meier survival curve analysis showed that the actual survival time in all three scores was not entirely consistent with the expected survival time. Tokuhashi score and revised score were positively correlated with the survival time while that of Tomita score was negative. Conclusion All the three prognosis scores in patients with spinal metastasis were closely related with survival time. The combination of Tokuhashi score and Tomita score may be applied to better predict postoperative survival prognosis and guide the surgical options for patients with spinal metastasis.