PTEN基因表达在IIB期骨肉瘤生存分析中的意义

The role of PTEN in multivariate survival analysis of osteosarcoma stage IIB

目的分析IIB期肢体骨肉瘤预后的相关因素,评价PTEN在IIB期骨肉瘤生存分析中的意义。方法收集1996～2001年IIB期肢体骨肉瘤资料完整病例标本64例,男38例,女26例,平均年龄21.4(7～52)岁。发病部位:肱骨近端10例,股骨远端28例,股骨近端3例,胫骨近端23例。收集患者年龄、性别、组织分型、是否保肢治疗、是否术前化疗、是否规律化疗、肿瘤大小等临床相关因素。所有患者标本进行PTEN免疫组织化学研究,多因素统计生存分析。结果64例骨肉瘤患者中复发11例,其中截肢患者中仅1例复发,占4.17%;保肢患者中10例复发,占25%,差异有统计学意义(P<0.05)。规律化疗组38例中3例复发,占7.89%;非规律化疗组26例中8例复发,占30.76%,差异有统计学意义(P<0.05)。64例骨肉瘤患者中肺转移29例,PTEN表达与肺转移相关(P=0.001)。规律化疗组38例中11例复发,占28.94%;非规律化疗组26例中18例复发,占69.23%,差异有统计学意义(P<0.01)。Cox模型分析肿瘤体积大是危险因素,而规律化疗和PTEN免疫染色阳性是保护因素。Keplan-Meier分析骨肉瘤患者PTEN阳性和规律化疗者生存期长。结论PTEN染色阳性是骨肉瘤患者预后的保护性因素,规律化疗是改善肢体骨肉瘤患者预后的关键。

Objective Methods From 1996 through 2001, 64 patients （38 males and 26 females） with osteosarcoma were treated. Their average age at diagnosis was 21.4 yrs, ranging from 7 yrs to 52 yrs. The sites of the tumors were proximal humors in 10 patients, distal femurs in 28, proximal femurs in 4 and proximal tibia in 23. Patients＇age, gender, pathological type, surgical options, preoperative chemotherapy, systemic chemotherapy and the size of tumors were recorded as correlation factor for survival analysis. Immunochemical analysis of PTEN was performed in all patients. A multivariate survival analysis was done on the basis on theses factors. Results The tumor recurrence was found in 11 patients out of the 64, however only in 1 out of these undergoing amputation and 10 out of these undergoing salvage surgery. The recurrence rate of the two group was 4.17% and 25%, respectively and there was significant difference （P〈0.05）. Local recurrence rate was 7.89 % （3 cases） in surgery with combined chemotherapy group （38 cases） and 30.76% （8 cases） in surgery with non-combined therapy group （26 cases）, showing a significant difference （P〈0.05）. Metastasis rate was 28.94 % （11 cases） in surgery with combined chemotherapy group （38 cases） and 69.23% （18 cases） in surgery with non-combined chemotherapy group （26 cases） （P〈0.01）. Additionally, the expression of PTEN was significantly related to pulmonary metastasis （P〈0.01）. The result of Cox model analysis demonstrated that the odds ratio of tumor size, systemic chemotherapy and positive expression of PTEN were 8.680, 0.116 and 0.265 respectively. Other clinical factors had no statistically significant correlation to the osteosarcoma prognosis. Keplan-Meier analysis showed the survival rates were higher in the group of patients with positive expression of PTEN or receiving systemic chemotherapy than in the group of patients with negative expression or receiving nonsystemic chemotherapy （P〈0.01）. Conclusions The positive expression of PTEN is the protecting factors for osteosarcoma. The combined therapy is essential for improving survival rate.