国人骨肉瘤化疗坏死率及体积变化与预后的关系

The survival of patients with osteosarcoma influenced by chemotherapy induced tumor necrosis and tumor volume variation,the Chinese experience

目的探讨国人骨肉瘤新辅助化疗效果的相关因素。方法回顾性研究2003年6月至2006年12月45例原发初治无转移的四肢成骨肉瘤患者。在进行了新辅助化疗+手术切除+术后化疗的标准治疗后,所有切除标本进行坏死率分析。将患者的年龄、性别、身高、肿瘤部位、血型、碱性磷酸酶水平、肿瘤体积等与肿瘤坏死率和预后进行相关分析,通过统计学方法找出相关的预后因素。结果新辅助化疗后肿瘤体积减小者14例,体积不变者20例,体积增大者11例。肿瘤坏死率≥90%者19例,肿瘤坏死率<90%者26例,患者平均随访时间26个月(3个月～46个月),3年无病生存率为60.6%。肿瘤坏死率高者预后较好,肿瘤坏死率与预后相关(P=0.028),化疗后肿瘤体积减小提示肿瘤坏死率较高,化疗前后肿瘤的体积变化与坏死率相关(γ2=7.929,P=0.019)。结论测量化疗前后肿瘤体积变化、分析肿瘤坏死率可以预测骨肉瘤的化疗效果,推测患者预后。

Objective To determine the prognostic factors that influence the survival of patients with nonmetastatic, high-grade osteosarcoma in the extremities in China. Methods A homogeneous group of 45 patients treated at Peking University People＇ s Hospital Musculoskeletal tumor center between June 2003 and December 2006, were retrospectively evaluated in terms of gender, age, height, tumor site and size, blood type, serum levels of alkaline phosphatase, protocol of chemotherapy, and histologic response to preoperative treatment. Results The number of patients with decreased TTV （total tumor volume） was 14; with stable TTV was 20; with increased TTV was 11. The number of patients with good histologic response was 19; with poor response was 26. The 3-year event-free survival was 60.6% after 3 to 46 months follow-up. Conclusions Event free survival （EFS） was related to the tumor necrosis. Tumor necrosis was related to the change of volume after preoperative chemotherapy. These factors must be considered when deciding risk-adapted treatments for osteosarcoma patients.