对影响新辅助化疗后骨肉瘤危险度的临床因素分析

Multivariate Analysis of Clinical Factors to Determine Risk Level for Patients with Osteosarcoma after Neoadjuvant Chemotherapy

目的:分析影响新辅助化疗后骨肉瘤危险度的临床因素,探索评价新辅助化疗后高危骨肉瘤的临床指标。方法:回顾分析1999年12月～2006年10月在济南军区总医院接受新辅助化疗的55例患者的临床特点、血液学检查及X线片表现等不同指标。随访期内出现复发、转移或死亡的患者归为高危组;反之归为低危组。运用统计学方法,分析各指标在高、低危患者间的差异。结果:55例患者中高危组25例(45%);正常生存者30例(55%)。经统计学分析发现除了化疗前肿瘤体积、化疗前AKP、化疗前LDH在两组之间存在差异外,余各项指标在两组之间均无统计学差异。结论:当化疗前AKP≥250IU/L、化疗前LDH≥240IU/L、化疗前肿瘤体积≥150cm^3即表明该类患者有较高的危险性,可考虑为高危骨肉瘤,预后较差。

Objective： To analyze the clinical factors that separate low- and high-risk osteosarcoma after neoadjuvant chemotherapy. Methods： Many indices, including clinical manifestation, hematological examination and X-ray changes, from 55 patients with osteosarcoma who were treated with neoadjuvant chemotherapy in the study department from December 1999 to December 2006 were reviewed. During follow-up, the patients were classified as having high-risk osteosarcoma if recurrence, metastasis or death occurred. If these events did not occur, the patients were classified as having low-risk osteosarcoma. Several indicators including general materials , tumor volume, X-ray type, X-ray scoring, AKP and LDH were recorded and analyzed with various statistical methods to study the difference between the high-risk and low-risk groups. Results： Fifty-five patients with osteosarcoma were followed up for 3 to 10 years. Of these, 25 patients developed recurrence or metastasis or died, and were classified as being in the high-risk group （45%）, and 30 patients with no recurrence or metastasis were classified as being in the low-risk group （55%）. The results of multivariate analysis showed there were no differences between the high-risk and low-risk groups in many regards, except for pre-chemotherapy tumor volume, pre-chemotherapy AKP and pre-chemotherapy LDH. Conclusion： A patient should be considered to have high-risk os- teosarcoma when pre-chemotherapy AKP ≥ 250 IU/L, pre-chemotherapy LDH ≥240 IU/L, and pre-chemotherapy tumor volume ≥150 cm3.