食管癌术后核素骨显像的影像学特征及发生骨骼转移的多因素分析
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摘要
目的：研究食管癌患者术后放射性核素骨骼显像的影像学特征,归纳其发生骨骼转移的规律和存在的主要危险因素,客观评价放射性核素全身骨扫描对食管癌的诊疗和随访价值。
方法：采用横断面分析方法,收集我院2000年至2007年进行过核素全身骨骼显像的201例食管癌手术患者病历资料,记录整理患者出现临床症状至手术的时间,局部或全身骨骼症状或体征,组织病理学类型,分化程度,确诊时或手术时的临床分期,肿瘤位置,术后辅助治疗情况,核素全身骨扫描的时间,骨骼显像结果。对应统计X线、CT、MRI骨骼检查资料及综合治疗方案。采用Log-rank检验单因素和COX逐步回归模型多因素进行统计。
结果：201例食管癌患者术后行核素全身骨扫描随访,发生骨转移43例。骨转移阳性率21.39%。其好发部位依次为脊柱、肋骨、骨盆、胸部骨骼、四肢及颅骨。结果中肋骨的假阳性率最高,脊柱次之。单因素分析结果显示：手术患者的手术时间、肿瘤位置、鳞癌分化程度、TNM分期、局部淋巴结是否转移、术后是否行规范化辅助放化疗、术后时间及局部骨骼症状与骨转移的发生有统计学意义。通过COX多因素回归分析发现：患者出现临床症状至手术的时间、鳞癌分化程度、TNM分期、局部淋巴结是否转移、术后规范化治疗情况是影响食管癌术后骨转移发生的主要因素。
结论：食管癌术后骨转移发生率为21.39%。最常转移的部位为脊柱,其次是肋骨。患者出现临床症状至手术的时间、鳞癌分化程度、TNM分期、局部淋巴结是否转移、术后规范化治疗情况是影响食管癌术后骨转移发生的主要因素。而术后一年内为骨转移的高发时间。对于食管癌术后出现局部骨痛的患者要考虑肿瘤骨转移的可能。明确这些危险因素及骨转移的高发时间有利于骨骼转移的早期发现和正确诊断。掌握食管癌骨转移的转移规律及引起核素全身骨显像结果假阳性的因素,有利于提高核医学诊断肿瘤骨转移的准确性。
Objective To study imaging features of radionuclide bone imaging in patients after esophagectomy; summarized the law of skeletal metastases and the major risk factors; evaluate the value of the radionuclide bone scanning in esophageal cancer treatment and follow-up objectively.
Methods A retrospective study was made on the clinical data of 201 esophagectomy cases from the year 2000 to 2007. Documenting the time between clinical symptoms to chemotherapy or surgery, local or systemic symptoms or signs of bone, histopathological type, differentiation, clinical stage, tumor location, adjuvant therapy, whole bone scan time, whole body scan results. X, CT, MRI bone scan results. Analyzed the risk factors influencing bone metastasis using statistical methods.
Results Among 201 esophagectomy patients, The rate of bone metastasis is 21.39%(43/201). In a review of the history records of 43 patients, the predilection sites were the spine, ribs, pelvis, chest bones, limbs and skull. The highest false positive rate of rib, spine followed in results. Univariate analysis showed that:Surgical operation time, tumor location, squamous cell differentiation, TNM stage, lymph node metastasis, postoperative adjuvant radiotherapy or chemotherapy are standardized row, the time after surgery and the symptoms of local bone related to bone metastasis. Through COX regression analysis found that:the clinical symptoms of patients to surgery, and squamous cell differentiation, TNM stage, local lymph node metastasis and standard postoperative treatment are the main factors of bone metastasis.
Conclusion The study indicates that incidence of esophageal cancer with bone metastasis is 21.39% in this article. Spine is the most common sites of metastasis, followed by ribs, pelvis, chest. Skull and limbs are accumulated less. Whole bone scan is used for diagnosis the bone metastasis of esophageal cancer patients with bone metastasis. Ribs and spine has the highest rate of false positive. This article shows that the clinical symptoms of patients to surgery, squamous cell differentiation, TNM stage, local lymph node metastasis and standard postoperative treatment are are primary risk factors which affect the bone metastasis of esophageal patients. Bone metastases occurred easily Within one year after surgery. Clear these risk factors and the time of high incidence of bone metastasis can help to diagnosis bone metastasis early and correctly. Understand the law of esophageal cancer's bone metastasis and the factors caused false positive results in radionuclide whole body bone scan are favorable for improve the accuracy of nuclear medicine diagnosis bone metastasis.
方法：采用横断面分析方法,收集我院2000年至2007年进行过核素全身骨骼显像的201例食管癌手术患者病历资料,记录整理患者出现临床症状至手术的时间,局部或全身骨骼症状或体征,组织病理学类型,分化程度,确诊时或手术时的临床分期,肿瘤位置,术后辅助治疗情况,核素全身骨扫描的时间,骨骼显像结果。对应统计X线、CT、MRI骨骼检查资料及综合治疗方案。采用Log-rank检验单因素和COX逐步回归模型多因素进行统计。
结果：201例食管癌患者术后行核素全身骨扫描随访,发生骨转移43例。骨转移阳性率21.39%。其好发部位依次为脊柱、肋骨、骨盆、胸部骨骼、四肢及颅骨。结果中肋骨的假阳性率最高,脊柱次之。单因素分析结果显示：手术患者的手术时间、肿瘤位置、鳞癌分化程度、TNM分期、局部淋巴结是否转移、术后是否行规范化辅助放化疗、术后时间及局部骨骼症状与骨转移的发生有统计学意义。通过COX多因素回归分析发现：患者出现临床症状至手术的时间、鳞癌分化程度、TNM分期、局部淋巴结是否转移、术后规范化治疗情况是影响食管癌术后骨转移发生的主要因素。
结论：食管癌术后骨转移发生率为21.39%。最常转移的部位为脊柱,其次是肋骨。患者出现临床症状至手术的时间、鳞癌分化程度、TNM分期、局部淋巴结是否转移、术后规范化治疗情况是影响食管癌术后骨转移发生的主要因素。而术后一年内为骨转移的高发时间。对于食管癌术后出现局部骨痛的患者要考虑肿瘤骨转移的可能。明确这些危险因素及骨转移的高发时间有利于骨骼转移的早期发现和正确诊断。掌握食管癌骨转移的转移规律及引起核素全身骨显像结果假阳性的因素,有利于提高核医学诊断肿瘤骨转移的准确性。
Objective To study imaging features of radionuclide bone imaging in patients after esophagectomy; summarized the law of skeletal metastases and the major risk factors; evaluate the value of the radionuclide bone scanning in esophageal cancer treatment and follow-up objectively.
Methods A retrospective study was made on the clinical data of 201 esophagectomy cases from the year 2000 to 2007. Documenting the time between clinical symptoms to chemotherapy or surgery, local or systemic symptoms or signs of bone, histopathological type, differentiation, clinical stage, tumor location, adjuvant therapy, whole bone scan time, whole body scan results. X, CT, MRI bone scan results. Analyzed the risk factors influencing bone metastasis using statistical methods.
Results Among 201 esophagectomy patients, The rate of bone metastasis is 21.39%(43/201). In a review of the history records of 43 patients, the predilection sites were the spine, ribs, pelvis, chest bones, limbs and skull. The highest false positive rate of rib, spine followed in results. Univariate analysis showed that:Surgical operation time, tumor location, squamous cell differentiation, TNM stage, lymph node metastasis, postoperative adjuvant radiotherapy or chemotherapy are standardized row, the time after surgery and the symptoms of local bone related to bone metastasis. Through COX regression analysis found that:the clinical symptoms of patients to surgery, and squamous cell differentiation, TNM stage, local lymph node metastasis and standard postoperative treatment are the main factors of bone metastasis.
Conclusion The study indicates that incidence of esophageal cancer with bone metastasis is 21.39% in this article. Spine is the most common sites of metastasis, followed by ribs, pelvis, chest. Skull and limbs are accumulated less. Whole bone scan is used for diagnosis the bone metastasis of esophageal cancer patients with bone metastasis. Ribs and spine has the highest rate of false positive. This article shows that the clinical symptoms of patients to surgery, squamous cell differentiation, TNM stage, local lymph node metastasis and standard postoperative treatment are are primary risk factors which affect the bone metastasis of esophageal patients. Bone metastases occurred easily Within one year after surgery. Clear these risk factors and the time of high incidence of bone metastasis can help to diagnosis bone metastasis early and correctly. Understand the law of esophageal cancer's bone metastasis and the factors caused false positive results in radionuclide whole body bone scan are favorable for improve the accuracy of nuclear medicine diagnosis bone metastasis.
引文
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[2]Mariette C, Fimzi L, Fabre S, et al. Factors predictive of complete resection of operable esophageal cancer:a pro-spective study[J]. Ann Thorac Surg,2003,75(6): 1720—1726.
[3]胡云,张青,苏红媛等.消化道肿瘤核素骨显像特点分析[J].重庆医学,2005,34(8)：1130.
[4]P Ryan, S McCarthy, J Kelly, et al. Prevalence of bone marrow micrometastases in esophagogastric cancer patients with and without neoadjuvant chemoradiotherapy [J]. J Surg Res,2004,117(3):121-126.
[5]X Jiao, MJ Krasna. Clinical significance of micrometastasis in lung and esophageal cancer:a new paradigm in thoracic oncology [J]. Ann Thorac Surg,2002,7(4): 278-284.
[6]R.Macadam, A.Sarela, J.Wilson. Bone marrow micrometastases predict early post-operative recurrence following surgical resection of oesophageal and gastric carcinoma[J]. European Journal of Surgical Oncology,2003,29(5):450-454.
[7]Leslie E, Quint, M.D, Lisa M, et al. Incidence and distribution of distant metastases from newly diagnosed esophageal carcinoma [J]. Cancer,1995,76(7):1120-1125.
[8]金星,林爱珠.全身核素骨显像对食管癌骨转移的诊断[J].中国误诊学杂志,2001,1(6)：833-833.
[9]王建方,赵新明,张敬勉等.食管癌骨转移骨显像的影像特征分析[J].现代中西医结合杂志.2007.16(22)：3216.
[10]马寄晓,刘秀杰主编.实用临床核医学：骨与关节疾病[M].原子能出版社,2002(第二版)：505.
[11]梁绍奖.显像与MRI对骨转移瘤的诊断价值比较[J].吉林医学,2008,9(17)：1427-1428.
[12]谭业颖,田嘉禾,椎体骨转移：MRI与核素骨扫描的对照分析[J].中华现代影像学杂志,2006,3(4)：339-340.
[13]Citrin DL, Fogelman I. A review of bone scanning in the evaluation of the cancer patient[J]. Appl Radiol Nucl Med,1980,9(6):102—110.
[14]O Schillaci. Hybrid SPECT/CT:a new era for SPECT imaging?[J]. Eur J Nucl Med Mol Imaging,2005,32(5):521-4.
[15]邓豪余,段华新,邱娟.乳腺癌患者腋窝淋巴结转移与骨转移关系[J].湖南医科大学学报,2001,26(3)：269-270.
[16]赵彦辉,乔文波,关美玉.不同病理类型肺癌骨转移全身骨显像分析[J].实用肿瘤学杂志,2000,14(3)：215-216.
[17]赵峰,李娟,刘保军等.消化系统恶性肿瘤164例骨显像分析[J].四川医学,2004,25(3)：324-325.
[18]叶小娟,何刚强,孙达.229例消化系统恶性肿瘤骨显像分析[J].浙江医学,2002,24(10)：640-641.
[19]汤钊猷.现代肿瘤学[M],上海复旦大学出版社,2006(2版)：1961.
[20]余英清,余燕武.钡餐造影与CT扫描在食道癌诊断中的价值[J].中国误诊学杂志,2006,6(2)：269-270.
[21]张莉华,谢文晖,俞志昌,1500例肺癌患者核素骨显像结果分析[J].中华核医学杂志,1999,19(1)：6-7.
[22]Haustermans K, Vanuytsel L, Geboes K. In vivo cell kinetic measurements in human oesophageal cancer:what can be learned from multiple biopsies?[J]. Eur J Cancer. 1994,30 (12):1787-1791.
[23]盛李明,胡琼舸,魏启春.胸段食管鳞状细胞癌淋巴结转移特点的临床分析[J].实用癌症杂志,2006,7(21)：396-8.
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