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[目的]分析骨的孤立性转移瘤预后相关因素,选择恰当的手术方式。[方法]2002年5月～2010年5月,共收治134例孤立性骨转移瘤患者,其中男76例,女58例,平均59岁。通过随访了解肿瘤学预后,明确1、3年总体生存率及局部复发率。通过回顾病例,分析年龄、性别、原发肿瘤类型、转移部位、有无病理骨折、有无内脏转移、外科边界以及诊断原发肿瘤至出现转移间隔时间8项因素对总体生存率的影响。利用Kaplan-Meier生存分析(log-rank检验)确定对生存率有影响的单个因素,并通过Cox回归进行多因素分析明确影响预后的独立危险因素。[结果]105例患者获得随访,随访率78.4%,中位随访时间32.4个月(3～80个月)。患者1、3年总体生存率和复发率分别为78.9%、40.7%和7.5%、23.8%,中位复发时间16个月。单因素分析结果提示:原发肿瘤为进展较慢的肾癌、甲状腺癌、乳腺癌、前列腺癌,行骨科手术时未出现其他脏器转移,取得广泛外科边界、无病理性骨折的患者预后较好(P<0.05)。多因素分析显示原发为进展较慢的肿瘤,行骨科手术时未出现其他脏器转移以及取得广泛外科边界是影响预后的独立危险因素。取得广泛外科边界同样是影响局部复发率的独立危险因素。[结论]原发肿瘤为进展较慢的肾癌、甲状腺癌、乳腺癌、前列腺癌,行骨科手术时未出现其他脏器转移以及取得广泛外科边界是影响预后的独立危险因素。
[Objective] To analyze the prognostic factors of solitary bone metastases in bone and select the appropriate surgical methods. [Method] From May 2002 to May 2010, a total of 134 patients with isolated bone metastases were treated, including 76 males and 58 females, with an average of 59 years. Through follow-up understanding of oncology prognosis, clear 1, 3 years overall survival and local recurrence rate. By retrospectively analyzing the effects of age, gender, primary tumor type, metastatic site, pathological fracture, visceral metastases, surgical boundaries, and the time between the diagnosis of the primary tumor and metastasis interval on the overall survival rate. A single factor influencing survival was determined using Kaplan-Meier survival analysis (log-rank test) and multivariate analysis using Cox regression identified independent risk factors that clearly influenced prognosis. [Results] 105 patients were followed up with a rate of 78.4%. The median follow-up time was 32.4 months (range 3-80 months). The 1-year and 3-year overall survival and recurrence rates were 78.9%, 40.7%, 7.5%, 23.8%, respectively. The median time to recurrence was 16 months. The results of univariate analysis showed that the primary tumors were slow progress of renal cell carcinoma, thyroid cancer, breast cancer and prostate cancer. No other organ metastases occurred during orthopedic surgery, and the prognosis of patients without extensive pathological fractures Good (P <0.05). Multivariate analysis showed that primary tumors were slower progressing, and no other organ metastases during orthopedic surgery and obtaining extensive surgical boundaries were independent risk factors for prognosis. Obtaining a wide range of surgical boundaries is also an independent risk factor for local recurrence. [Conclusion] The primary tumors are slow progress of renal, thyroid, breast and prostate cancer. No other organ metastases and extensive surgical boundaries are the independent risk factors for prognosis in orthopedic surgery.