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目的:探讨Tomita评分在脊柱转移癌治疗决策与生存时间预测中的作用。方法:回顾性分析2002年1月～2008年12月在我院收治的脊柱转移癌患者108例,男66例,女42例,年龄17～86岁,平均57.9岁。手术治疗44例,保守治疗64例。通过Tomita评分系统进行评分,并根据不同分值分为4组,2～3分者为A组;4～5分者为B组;6～7分者为C组;8～10分者为D组,对4组脊柱转移癌患者的术后生存时间(有完全数据者105例,截尾数据3例)进行统计和生存分析比较。结果:随访2～46个月,平均14.7个月。末次随访截至于2011年7月,有1例存活,失访2例,108例总平均生存时间10.3个月,中位生存时间8个月,1年生存率31.48%,其中A组4例,平均生存时间24.75个月,中位生存时间15个月,1年生存率75%;B组18例平均生存时间15.58个月,中位生存时间15个月,1年生存率66.66%;C组31例平均生存时间11.74个月,中位生存时间11个月,1年生存率48.39%;D组55例平均生存时间6.65个月,中位生存时间6个月,1年生存率7.27%。采用Log-rank检验对资料进行非参数估计对4组生存时间分析提示有显著性差异(P<0.001)。采用Spearman等级相关分析结果表明生存时间与Tomita预后评分呈负相关,Tomita评分分值较低者,其生存时间较长,预后相对较好,二者之间关系系数r=-0.5868(P<0.001)。结论:Tomita预后评分与脊柱转移癌患者的预后密切相关,其评分结果可作为脊柱转移癌保守或手术治疗决策的重要参考指标。
Objective: To investigate the role of Tomita score in predicting the survival of patients with spinal metastasis. Methods: A retrospective analysis of 108 patients with spinal metastases who were treated in our hospital from January 2002 to December 2008 was retrospectively analyzed. There were 66 males and 42 females, aged from 17 to 86 years (average 57.9 years). Surgical treatment of 44 cases, 64 cases of conservative treatment. The patients were divided into 4 groups according to the scores of Tomita and divided into 4 groups according to different scores: group A was 2 to 3; group B was 4 to 5; group C was 6 to 7; group C was 8 to 10 In group D, the survival time (105 cases with complete data and 3 cases with censored data) of 4 patients with metastatic spine was analyzed statistically and survival analysis. Results: The follow-up ranged from 2 to 46 months with an average of 14.7 months. The last follow-up As of July 2011, there were 1 case of survival and 2 cases of loss of follow-up. The overall average survival time of 108 cases was 10.3 months, the median survival time was 8 months and the 1-year survival rate was 31.48% The average survival time was 24.75 months, the median survival time was 15 months and the 1-year survival rate was 75%. In group B, the average survival time was 15.58 months, the median survival time was 15 months and the 1-year survival rate was 66.66% The average survival time was 11.74 months, the median survival time was 11 months and the 1-year survival rate was 48.39%. The average survival time was 55.5 months in group D, the median survival time was 6 months, and the 1-year survival rate was 7.27%. Log-rank test using nonparametric estimates of data on the four groups showed significant differences in survival time analysis (P <0.001). The Spearman rank correlation analysis showed that the survival time was negatively correlated with the Tomita prognosis score. The lower the Tomita score, the longer the survival time was, the better the prognosis was. The correlation coefficient was -0.5868 (P <0.001) ). Conclusion: The prognosis score of Tomita is closely related to the prognosis of patients with spinal metastasis. The scoring results can be used as an important reference for the conservative or surgical treatment of spinal metastases.