四肢Ⅱ期骨肉瘤的化疗效果评价

Evaluation of neoadjuvant chemotherapy for patients with stage II osteosarcoma

目的对四肢骨肉瘤患者实施化疗的效果以及与生存率的关系进行总结。方法1997年7月至2007年7月采用新辅助化疗及手术治疗ⅡB期骨肉瘤患者296例，其中男性184例，女性112例，年龄7～65岁。其中股骨近端10例，股骨干部7例，股骨远端148例，胫骨近端80例，胫骨远端5例，腓骨11例，肱骨33例，桡骨远端2例。外科分期（Enneking分期）：6例为ⅡA期，290例为ⅡB期。对所有病例进行术前化疗反应评估，72例进行肿瘤坏死率分析。结果296例患者平均随访时间47个月，出现远处转移98例，占33．1％。对术前化疗反应明显有效的103例患者中，15．5％出现转移；部分有效的145例患者中，31．O％出现转移；术前化疗无效的48例患者77．1％出现转移。在坏死率分析研究中，化疗后肿瘤体积明显缩小、肿瘤边界变清晰的病例，肿瘤坏死率明显升高。结论骨肉瘤一旦诊断明确，应尽早给予化疗，化疗效果良好的患者，全身转移的可能性减小，无瘤生存率高。

Objective To retrospectively review the effect of chemotherapy and survival rate of osteosarcoma in extremity. Methods Between July 1997 and July 2007, 296 patients with osteosarcoma received neo-adjuvant chemotherapy and surgery. There were 184 males and 112 females, with age between 7 and 65 years. The tumors located in proximal femur in 10 patients, diaphyseal of femur in 7, distal femur in 148, proximal tibia in 80, distal tibia in 5, fibula in 11, humerus in 33, and distal radius in 2 patients. According to Enneking stage system, 6 patients were in stage Ⅱ A and others in stage ⅡB. All patients received evaluation of preoperative chemotherapy, and 72 patients had analysis of tumor necrosis after operation. Results After mean follow-up of 47 months, metastasis developed in 98 （33.1% ） patients. The metastatic rate was 15.5%, 31.0%, and 77.1% in patients with substantial effective chemotherapy, partial effective chemotherapy, and no effective chemotherapy, respectively. In tumor necrosis analysis, reduction of tumor volume and more clear margin after preoperative chemotherapy were related to higher tumor necrosis. Conclusions The patients with osteosarcoma should receive chemotherapy as soon as possible. More effective chemotherapy means lower metastatic rate and higher no event survival rate.