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目的探讨食管癌骨转移患者的临床特征及预后。方法选取1981年3月至2012年12月间收治的1 383例接受骨扫描检查的食管癌患者,分析其中131例骨扫描确诊骨转移患者的资料。结果食管癌骨转移的发生率为9.5%,自确诊食管癌至骨转移的中位时间为8.4个月,骨转移后中位生存时间为6.6个月,1年生存率为26.2%。脊柱转移率明显高于其他骨转移部位,其中尤以胸椎转移率最高(23.4%),其次为骨盆49例(20.8%)、肋骨42例(18.2%)、腰椎36例(15.6%)。多发病灶82例(62.6%),单发病灶49例(37.4%)。食管癌不同原发部位间在骨转移部位的分布上无统计学差异,初诊时有淋巴结转移者骨盆转移率高于无淋巴结转移转移者。单因素分析结果显示,骨痛治疗后缓解、骨转移的治疗、骨盆转移与食管癌骨转移患者的预后有关(均P<0.05)。多因素分析结果显示,骨转移的治疗、骨盆转移是食管癌骨转移患者预后的独立因素。结论食管癌骨转移预后较差,骨盆转移影响预后,放化疗治疗可能给患者带来生存获益。
Objective To investigate the clinical features and prognosis of patients with esophageal bone metastasis. Methods A total of 1 383 esophageal cancer patients undergoing bone scan between March 1981 and December 2012 were enrolled in this study. The data of 131 patients with bone metastases diagnosed by bone scan were analyzed. Results The incidence of esophageal bone metastasis was 9.5%, the median time from diagnosis of esophageal cancer to bone metastasis was 8.4 months, the median survival time after bone metastasis was 6.6 months, and the 1-year survival rate was 26.2%. The rate of spine metastasis was significantly higher than that of other bone metastases, especially in the thoracic vertebra (23.4%), followed by pelvis in 49 cases (20.8%), ribs in 42 cases (18.2%) and lumbar spine in 36 cases (15.6%). Multiple lesions in 82 cases (62.6%), single lesions in 49 cases (37.4%). There was no significant difference in the distribution of bone metastases between different primary sites of esophageal cancer. The pelvic metastasis rate of patients with lymph node metastasis was higher than that without lymph node metastasis. Univariate analysis showed that the relief of bone pain, the treatment of bone metastases, the pelvic metastasis and the prognosis of patients with esophageal bone metastasis (all P <0.05). Multivariate analysis showed that the treatment of bone metastases, pelvic metastasis of esophageal cancer patients with bone metastasis prognosis of independent factors. Conclusions The prognosis of esophageal bone metastasis is poor, and pelvic metastasis affects prognosis. Radiotherapy and chemotherapy may bring survival benefit to patients.