【摘要】 目的:骨的恶性纤维组织细胞瘤(MFHb)是一种少见的骨源性肉瘤,化疗对其疗效显著,在综合治疗中有重要作用。目前尚无研究对MFHb的临床、病理及治疗进行预后分析,化疗对局部控制的作用亦未阐明。本研究旨在分析MFHb的预后相关因素,探讨化疗在保肢及局部治疗方面的作用。方法:回顾性分析了42例高度恶性MFHb患者,中位年龄为41岁(11～69岁)。对临床、病理与治疗变量对总生存(OS)、无转移生存(DRFS)的影响进行Kaplan-Meier的单因素分析及Cox比例风险模型的多因素分析,同时分析化疗对保肢及局部复发的影响。结果:所有患者随访31个月(2～180个月),18例患者死亡,2年和5年OS分别为79%和45%。共20例出现远处转移,2年和5年DRFS分别为79%和47%。多因素分析中,R2切除和肿瘤位于中轴部位明显影响预后。化疗可增加局部进展期患者的保肢率。结论:高度恶性MFHb预后较差,R2切除和肿瘤位于中轴部位预示预后不良。化疗在增加保肢率方面有一定作用。更多还原

【Abstract】 Objective:To analyze the outcome of malignant fibrous histiocytoma of bone (MFHb) and the effect of chemotherapy on limb-salvaging and local outcomes.Methods:Forty-two patients with a median age of 41 years (range, 11-69) who had high grade MFHb were retrospectively analyzed.The clinical,pathologic,and treatment variables were analyzed for overall survival (OS) and distant-recurrence-free survival (DRFS).The impact of chemotherapy on limb-salvaging and prognosis were also analyzed.Results:With a median follow-up of 31 months (range,2-180),18 patients succumbed to their disease,giving a 2-year and 5-year OS rate of 79% and 45%,respectively.Twenty cases developed distant recurrence, giving a 2-year and 5-year DRFS rate of 79% and 47%,respectively.In multivariate analysis,R2 resection and axial location were significantly associated with poor prognosis.Chemotherapy was effective in increasing the limb-salvage rate in patients with locally advanced disease.Conclusion:High grade MFHb has poor prognosis even when patients receive multimodal treatment.R2 resection and axial location of tumor are independent prognostic factors associated with poor prognosis.Chemotherapy may play an important role in increasing the limb-salvage rate without sacrificing local control.更多还原