影响ⅡB期骨肉瘤术前化疗疗效的多因素分析

Multivariate Analysis of Factors Influencing on Preoperative Chemotherapy Response for Osteosarcoma

目的探讨和分析相关因素在影响骨肉瘤术前化疗疗效中的意义。方法分析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,行多因素Logistic回归分析上述因素对TCNR的影响。结果40例中24例的TCNR>90%(60%);通过单因素分析及多因素非条件Logistic回归分析发现肿瘤体积、化疗后AKP、白细胞最低值及化疗方案与TCNR有相关性(P=0.020,P=0.024,P=0.034,P=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术前化疗疗效的最主要因素。肿瘤体积大及化疗后AKP水平高是术前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术前化疗疗效;DIA方案的疗效优于MMIA方案。

Objective To study the correlation between tumor cell necrosis rate（TCNR） and the possible factors influencing preoperative chemotherapy response for osteosarcoma,with multivariate and univaried analysis,and to investigate the value of those factors in predicting the chemotherapy response.Methods Using clinic opatholigical date of 40 patients with osteosarcoma in our hospital treated with preoperative chemotherapy,the factors such as gender,age,location,duration of symptoms,tumor volume,pre-and post-chemotherapy AKP and LDH,the expression of Pgp before treatment,chemotherapy protocol,the lowest level of blood leucocytes and lymphocyte after chemotherapy,and the type of x-ray appearance,were analyzed and evaluated 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%）.We found that,with univaried factor analysis and multivariate non-conditional logistic regression analysis,the relationship existed between TCNR and tumor volume,post-chemotherapy AKP,the lowest level of post-chemotherapy peripheral blood leucocytes and chemotherapy protocol.Conclusion The major factors influencing preoperative chemotherapy response were tumor volume,post-chemotherapy AKP,the lowest level of post-chemotherapy peripheral blood leucocytes and chemotherapy protocol.Larger tumor volume and higher post-chemotherapy AKP were risk factors and predicted poor chemotherapy response.The lowest level of post-chemotherapy blood leucocytes could reflect the chemotherapy response indirectly;the chemotherapy response of DIA protocol was much better than that of MMIA.