【作者】 于秀淳； 王伟；

【Author】 Yu Xiu - Chun Wang Wei Orthopedics Department,The General Hospital of Jinan military Commanding Region, Jinan 250031

【机构】 济南军区总医院骨病科；

【摘要】 目的:通过单因素分析和多因素分析的方法探讨相关因素在影响骨肉瘤化疗疗效中的意义。方法:统计并分析我院40例骨肉瘤患者的性别、年龄、部位、病程、肿瘤体积、AKP和LDH、化疗前骨肉瘤Pgp表达、化疗方案、化疗后白细胞和淋巴细胞最低值以及X线类型等因素的特点,及上述因素在化疗前后的变化对TCNR的影响,并行多因素Logistic回归分析。结果:40例患者中24例的TCNR>90％(60％);研究发现临床表现和X线表现的难以评价化疗疗效;在各分类变量中,性别、病变部位、X线类型、化疗前Pgp的表达与TCNR之间无相关性(分别P=0．069,0．660,0．533,0．151);化疗方案(MMIA和 DIA)与TCNR存在显著相关性(P=0．037)。在数值型变量中,TCNR与肿瘤体积、化疗后AKP水平及白细胞最低值存在相关性(分别P=0．002,0．014,0．033),化疗前LDH与TCNR的相关性在临界范围(P=0．054),与其他因素无相关性。多因素非条件Logistic回归分析发现肿瘤的体积、化疗后AKP、白细胞最低值及化疗方案与TCNR有相关性(分别P=0．020,0．024, 0．034,0．034),并得出了相关回归方程。结论:肿瘤体积、化疗后AKP、化疗后白细胞最低值和化疗方案是影响骨肉瘤化疗疗效的最主要因素。肿瘤体积大及化疗后AKP水平高是化疗疗效差的危险因素;化疗后白细胞下降的程度可以间接反映化疗疗效;DIA方案的疗效优于MMIA方案。更多还原

【Abstract】 Objective:To study the correlation between tumor cell necrosis rate (TCNR) and the possible factors influencing chemotherapy response for osteosarcoma, with multivariate and univariate analysis, and to investigate the values of those factors in predicting the chemotherapy response.Methods: Analyzing the factors from 40 patients with osteosarcoma in our hospital treated with neoadjuvant chemotherapy, such as gender, age, location, duration of symptoms, tumor volume,pre- and post- chemotherapy AKP and LDH levels, the express of Pgp before treatment, chemotherapy protocol, the lowest level of blood leucocytes and lymphocyte after treatment, and the type of X - ray appearance, and calculating TCNR after operation. and demanding the influencing pre - and post - chemotherapy changes of the above factors on chemotherapy response with multivariate logistic regression. Results: Among 40 patients,24 with TCNR above 90% (60% ); It was difficult to predict the chemotherapy response with clinical and radiographic appearance. Among categorical variables, there was no relationship between TCNR with gender,location,the type of X- ray appearance,and the express of Pgp before treatment,but chemotherapy protocol was significantly associated with TCNR. In numerical variables, no correlation was found between TCNR and the variables,such as age, duration of symptoms, pre - chemotherapy AKP level, post - chemotherapy LDH, and the lowest level of post - chemotherapy peripheral blood lymphocytes (P>0.05), but we found that TCNR was associated with tumor volume, post- chemotherapy AKP and the lowest level of post -chemotherapy peripheral blood leucocytes (P < 0.05). The results, from multivariate non - conditional logistic regression analysis, showed that the relationship existed between TCNR and tumor volume, post - chemotherapy AKP, the lowest level of post - chemotherapy peripheral blood leucocytes and chemotherapy protocol. Conclusions: the major factors influencing chemotherapy response were tumor volume, post -chemotherapy AKP, the lowest level of post - chemotherapy peripheral blood leucocytes and chemotherapy protocol. It were the risk factors, such as larger tumor volume and higher post - chemotherapy AKP, predicting poor chemotherapy response. The lowest level of post - chemo- therapy blood leucocytes could reflect the chemotherapy response indirectly;the chemotherapy response of DIA protocol was much better than that of MMIA.更多还原