【摘要】 目的探讨临床相关因素对肢体骨肉瘤患者预后的影响。方法回顾性分析2000年6月至2016年3月国内7家骨肉瘤治疗中心收治的479例肢体骨肉瘤患者的病历资料,记录一般情况、治疗方式、并发症、复发转移及生存情况,应用Kaplan-meier、Cox regression等统计学方法分析各变量与预后的关系。结果 479例肢体骨肉瘤患者,男292例,女187例;年龄范围3~74岁(平均21.4岁);膝关节周围396例(包括股骨远端253例、胫骨近端125例及腓骨近端18例),膝关节以外83例(包括股骨近端24例、胫骨远端17例、肱骨近端34例、肱骨远端5例及桡骨3例);3年和5年总生存率分别为71.0%、60.0%,3年和5年无瘤生存率分别是54.0%、46.0%。5年总生存率:规范化疗组与非规范化疗组分别为73.0%、55.9%;术前三药联合组(DDP+IFO+ADM)和四药联合组(DDP+IFO+ADM+MTX)分别为48.7%、66.0%;术后三药联合组和四药联合组分别为51.5%、66.2%;肿瘤细胞坏死率≥90.0%组和<90.0%组分别为93.3%、40.3%;保肢术组和截肢术组分别为61.9%、43.3%;外科分期II期和III期分别为61.9%、25.1%;术后无复发转移、单纯局部复发、单纯肺转移、多发转移分别为93.5%、46.3%、20.7%、10.1%。单因素分析显示:规范性化疗、化疗方案、肿瘤细胞坏死率、手术方式、外科分期、复发转移是影响骨肉瘤患者生存预后的重要因素。Cox回归分析显示:规范性化疗、肿瘤细胞坏死率、手术方式及复发转移是影响患者的生存预后的独立因素。结论规范性化疗联合手术切除能够明显提高肢体骨肉瘤患者的生存率,复发转移与不规范化疗严重影响肢体骨肉瘤患者的预后。更多还原

【Abstract】 Objective To explore effects of clinical factors on the prognosis of limb osteosarcoma. Methods Clinical data of 479 patients with limb osteosarcoma, registered from June 2000 to March 2016 in seven cancer centers in China, were retrospectively collected. Clinical conditions, treatment method, complication, recurrence and metastasis as well as prognosis were recorded and analyzed. Kaplan-Meier survival curve and Cox regression model were used to analyze the correlation between the survival rate and variables factors. Results There were 292 males and 187 females among 479 patients, aged from 3 to 74 years( average 21.4 years). Tumors located around the knee joint in 396 patients( 253 cases of the distal femur, 125 cases of the proximal tibia and 18 cases of the proximal fibula), while beyond the knee in 83 patients( 24 cases of the proximal femur, 17 cases of the distal tibia, 34 cases of the proximal humerus, 5 cases of the distal humerus and 3 cases of the radius). 3 and 5-year overall survival were 71.0%, 60.0%, respectively. 3 and 5-year disease-free survival were 54.0%, 46.0%, respectively. 5-year overall survival were 73.0% standard chemotherapy and 55.9% non-standard chemotherapy; 48.7% three medicine combination( DDP + IFO + ADM) and 66.0% four medicine combination( DDP + IFO + ADM + MTX) preoperatively; 51.5% three medicine combination( DDP + IFO + ADM) and 66.2% four medicine combination( DDP + IFO + ADM + MTX) postoperatively; 93.3% tumor necrosis rate ≥90.0% and 40.3% tumor necrosis rate < 90.0%; 61.9% limb-salvage surgery and 43.3% amputation; 61.9% Enneking stage II and 25.1% Enneking stage III; 93.5% no recurrence, 46.3% local recurrence, 20.7% lung metastasis and 10.1% recurrence and metastasis postoperatively. Single factor analysis showed that standard chemotherapy, chemotherapy regimens, tumor necrosis rate, surgery, the Enneking stage and recurrence and metastasis were important to the prognosis of limb osteosarcoma. Cox regression analysis showed that standard chemotherapy, tumor necrosis rate, surgery approach and recurrence and metastasis were independent factors to the prognosis of limb osteosarcoma. Conclusions Survival rate of patients with limb osteosarcoma can be significantly improved by combining the standard chemotherapy and surgery. Recurrence and metastasis, non-standard chemotherapy severely affect the prognosis of limb osteosarcoma.更多还原