【摘要】 目的分析肢体原发成骨肉瘤综合治疗疗效,对影响局部复发的因素进行评估。方法1992年至2001年共收治术前无远处转移的肢体成骨肉瘤患者189例,平均年龄18岁,男性126例,女性63例;肿瘤部位:股骨下段86例,胫骨上段52例,四肢其他部位51例,病理骨折22例。完成化疗方案的患者为规律化疗组116例(61.4%);未完成化疗方案的患者为非规律化疗组73例(38.6%)。规律化疗组依手术方法分为保肢组90例和截肢组26例;非规律化疗组中保肢组42例和截肢组31例。采用卡方检验分别分析复发与性别、年龄、部位、病理骨折、就诊时碱性磷酸酶(AKP)值、术前化疗后 AKP 值、术前是否规律化疗、手术方式、外科边界、肿瘤大小、术后是否规律化疗、远隔转移等因素的关系。采用 Logistic 回归对复发的相关因素进行多因素分析。结果单因素卡方分析显示术前化疗后 AKP 值、手术方式、外科边界、化疗等因素与局部复发相关,而性别、年龄和部位等因素与复发相关性不显著。多因素 Logistic 回归分析显示外科边界和术前化疗后 AKP 是影响复发的两个最重要的因素。结论局部复发的发生与肿瘤的外科边界关系密切,恰当地选择外科边界可以提高保肢的安全性。局部复发与肿瘤转移高度相关,不恰当的外科治疗及化疗,危及患者的生存。更多还原

【Abstract】 Objective To evaluate the prognostic factors for the local recurrence of osteosarcoma in extremities treated with combined therapy.Methods Between 1992 and 2001,189 patients with non- metastatic osteosarcoma were treated.The average age at diagnosis was 18 years old.Tumors were located in the distal femur in 86 patients,proximal tibia in 52,and other locations in 51.Pathologic fracture occurred in 22 cases.One hundred and sixteen patients received combined therapy,73 patients underwent non- combined therapy(tumor resection only or unfinished chemotherapy).In the combined therapy group,90 patients underwent limb salvage surgery and 26 patients received amputations.In the non-combined therapy group,42 patients underwent limb salvage surgery and 31 patients received amputations.With Crosstabs analysis,local recurrence rates were retrospectively evaluated in relation to gender,age,tumor site, pathologic fracture,serum level of alkaline phosphatase,protocol of chemotherapy,type of surgery,surgical margin,size of tumor,and postoperative chemotherapy.Multiple factors were analyzed by Logistic regression analysis.Results The 5-year-survival rate was 78.5% in the combined therapy group and 35.1% in the non-combined therapy group.Local recurrence rate was 16.6%(15 cases)in limb salvage surgery with combined therapy group(90 cases)and 38.1%(16 cases)in limb salvage surgery with non-combined therapy group(42 cases)(P<0.001).Metastasis rate was 28.4%(33 cases)in the combined therapy group(116 cases)and 65.7%(48 cases)in the non-combined therapy group(73 cases)(P<0.000). The local recurrence rate was significantly related to serum level of alkaline phosphatase after preoperative chemotherapy,type of surgery,surgical margin and chemotherapy protocol.Moreover,Logistic regression revealed that surgical margin and serum level of alkaline phosphatase after preoperative chemotherapy were the key factors affecting the local recurrence.Conclusions The local recurrence is related to the surgical margin.The adequate surgical margin is very important for the limb salvage.The local recurrence is highly related to metastasis.The inadequate surgical treatment would damage the survival of patients with osteosarcoma.更多还原