Aim: The impact of occult vertebral fracture (OVF) on oncological outcomes after surgery has not been investigated, although its significance in orthopedics has been much debated recently. We evaluated the prognostic significance of OVF on the long-term outcomes of patients with colorectal liver metastases (CRLM) after hepatectomy. Methods: We included 140 patients with CRLM who underwent hepatectomy. OVF was identified using quantitative measurement and preoperative sagittal computed tomography image reconstruction from the 11th thoracic vertebra to the 5th lumber vertebra. Results: OVF was identified in 48 (34%) of the patients. In multivariate analysis, lymph node metastases (p< 0.01), multiple tumors (p= 0.02), extrahepatic lesions (p< 0.01), OVF (p< 0.01), intraoperative bleeding (p= 0.04), and curability 1 or 2 (p< 0.01) were independent and significant predictors of disease-free survival and extrahepatic lesions (p< 0.01), osteosarcopenia (p= 0.02), and OVF (p< 0.01) were independent and significant predictors of overall survival. A higher age, adjuvant chemotherapy for a primary lesion before metachronous liver metastases, osteopenia, and hypoalbuminemia were independent risk factors for OVF. Conclusions: The evaluation of preoperative OVF is a useful prognostic factor for risk stratification and clinical decision-making for patients with CRLM.
目的：隐匿性椎体骨折（OVF）对术后肿瘤学结局的影响尚未得到研究，尽管其在骨科领域的重要性近来备受争议。本研究旨在评估OVF对结直肠癌肝转移（CRLM）患者肝切除术后长期预后的预测价值。方法：我们纳入了140例接受肝切除术的CRLM患者。通过定量测量及术前第11胸椎至第5腰椎的矢状位计算机断层扫描图像重建技术识别OVF。结果：在140例患者中，48例（34%）被检测出OVF。多变量分析显示，淋巴结转移（p<0.01）、多发性肿瘤（p=0.02）、肝外病灶（p<0.01）、OVF（p<0.01）、术中出血（p=0.04）以及根治度分级1或2（p<0.01）是无病生存期的独立显著预测因子；而肝外病灶（p<0.01）、骨肌减少症（p=0.02）和OVF（p<0.01）是总生存期的独立显著预测因子。高龄、异时性肝转移前原发灶辅助化疗、骨质减少及低白蛋白血症是OVF的独立危险因素。结论：术前评估OVF可作为CRLM患者风险分层和临床决策的有效预后指标。
肿瘤(癌症)患者之家