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目的:探讨年龄对活动脊柱节段骨巨细胞瘤预后的影响。方法:回顾我院1989年3月~2011年12月经手术治疗的62例活动脊柱节段骨巨细胞瘤病例,其中男25例,女37例,年龄11~68岁,平均32岁。病变位于颈椎28例,胸椎24例,腰椎10例;单节段36例,≥2个节段26例。术前Enneking分期S2期2例,S3期60例。根据WBB分期,仅累及后方附件结构2例,仅累及前方椎体结构15例,同时累及前后方结构45例。共53例得到随访,中位随访时间为63个月(5~292个月),非死亡病例随访均超过21个月。以25岁为界进行年龄分组,用SPSS软件研究不同年龄组患者术前影像学累及节段、累及广泛程度的差异。对术前Enneking分期为S3期、手术方式采用包膜外分块切除术的病例,按上述年龄分组方法分组,用Kaplan-Meier统计方法分析两年龄组间无复发生存率的差异;再按年龄每10岁一档进一步分组,通过线性卡方统计方法观察各年龄组间术后复发率的变化趋势。结果:≤25岁组20例,>25岁组42例。≤25岁组累及≥2个节段6例(6/20),>25岁组20例(20/42)例,两组比较无统计学差异(P=0.1)。≤25岁组中,单独累及附件2例,单独累及椎体7例,同时累及前后方结构11例;>25岁组中,单独累及椎体8例,同时累及前后方结构34例,两组肿瘤累及部位有统计学差异(P=0.03)。获得随访的53例患者中,共有18例术后复发,复发率32%;中位复发时间12个月(2~200个月),共有6例复发时间超过术后2年,分别为30、37、38、42、94和200个月。在Enneking分期为S3期(除外恶性骨巨细胞瘤1例)并采用经瘤包膜外分块切除术的35例患者中,≤25岁组12例,无复发,平均无复发生存时间为59.8个月;>25岁组23例,9例复发,平均无复发生存时间为65个月,两组的无复发生存率比较有统计学差异(P=0.03)。将此35例患者按年龄每10岁一档分组,11~20岁组6例,无复发;21~30组13例,3例复发,复发率23%;31~40组6例,2例复发,复发率33.3%;41~50组7例,4例复发,复发率57.1%;线性卡方分析结果显示,各组间复发率呈递增趋势(P=0.02)。结论:在Enneking分期相同并采用相同手术方式的前提下,年龄可能是影响活动脊柱节段骨巨细胞瘤术后复发的因素之一,年轻患者预后较好。
Objective: To investigate the effect of age on the prognosis of active giant cell tumor of the spine. Methods: From March 1989 to December 2011, 62 cases of giant cell tumor of the spine were treated by surgery. There were 25 males and 37 females, aged from 11 to 68 years (average 32 years old). The lesions were located in 28 cases of cervical spine, 24 cases of thoracic spine and 10 cases of lumbar spine. Thirty-six cases were single-segment, 26 cases were ≥2 segments. Preoperative Enneking stage S2 in 2 cases, S3 in 60 cases. According to the WBB staging, only the posterior appendage structure was involved in 2 cases, involving only the anterior vertebral body structure in 15 cases, while involving the anterior and posterior structures in 45 cases. A total of 53 patients were followed up for a median follow-up of 63 months (range 5- 292 months). Non-fatal cases were followed up for more than 21 months. The 25-year-old community was divided into groups. SPSS software was used to study the preoperative imaging involving segments of different age groups, involving a wide range of differences. Preoperative Enneking staging was S3, the surgical method using extracapsular block resection cases, according to the above age grouping method, using Kaplan-Meier statistical analysis of the difference between the two groups no recurrence survival rate; by age Each 10-year-old file further grouping, by linear statistical methods to observe the trend of postoperative recurrence rate among different age groups. Results: There were 20 cases ≤25 years old and 42 cases> 25 years old. There were no significant differences between the two groups (P = 0.1) in 6 cases (6/20) and ≥25 years old group (20/42). ≤25 years old group, involving two separate annexes, involving the vertebral body in 7 cases alone, involving both anterior and posterior structures in 11 cases;> 25 years old group, involving vertebral body in 8 cases alone, involving both anterior and posterior structures 34 cases, two groups Tumor involvement sites were statistically different (P = 0.03). Among the 53 patients who were followed up, 18 cases had recurrence and recurrence rate of 32%. The median time to recurrence was 12 months (range, 2-200 months). A total of 6 patients had recurrence time more than 2 years after surgery, 37, 38, 42, 94 and 200 months. Of the 35 patients who underwent Enneking stage S3 (except 1 giant cell tumor of malignant bone) and had undergone subcutaneous tumor resection, 12 patients ≤25 years of age had no recurrence with an average recurrence-free survival of 59.8 Months; 23 patients aged> 25 years and 9 patients relapsed with an average recurrence-free survival time of 65 months. There was a significant difference in recurrence-free survival between the two groups (P = 0.03). Thirty-five patients were grouped according to their age at the age of 10 years. There were 6 patients in the age group of 11 to 20 years without recurrence. Thirteen patients in the 21-30 group had recurrence at a recurrence rate of 23%. Six patients in the 31-40 group and 2 patients Recurrence and recurrence rate was 33.3%. There were 7 cases in 41 ~ 50 cases and 4 cases relapsed with a recurrence rate of 57.1%. The linear chi-square analysis showed that the recurrence rate showed an increasing trend among the groups (P = 0.02). Conclusion: Under the premise of the same stage of Enneking and using the same surgical method, age may be one of the factors that influence the recurrence of active giant cell tumor of spine segment. The prognosis of younger patients is better.