骨肉瘤患者化疗后肿瘤坏死率与预后的相关性研究

Research on tumor necrosis rate in evaluating preoperative chemotherapy of osteosarcoma

目的探讨骨肉瘤术前化疗后的肿瘤坏死率与预后的关系。方法选取2000年3月至2004年3月初诊经活检病理组织学诊断为骨肉瘤且经影像学检查排除远处转移的40例患者,术前给予大剂量甲氨蝶呤、阿霉素、顺铂和异环磷酰胺化疗1周期。根据对手术切除肿瘤标本的肿瘤坏死率测定将患者分为两组(肿瘤坏死率≥90%和<90%),分别随访两组患者的术后肺转移率和5年生存率并进行比较。结果 40例骨肉瘤患者中肿瘤坏死率≥90%组为23例,<90%组为17例,两组的术后肺转移率分别为21.7%和70.6%(χ2=11.831,P=0.001),5年生存率分别为78.3%和23.5%(χ2=9.545,P=0.002)。结论肿瘤坏死率测定是评价骨肉瘤术前化疗反应最直接可靠的方法,获肿瘤坏死率≥90%患者的远期转移率和生存时间优于肿瘤坏死率<90%患者。

Objective To discuss the relationship between tumor necrosis rate of preoperative chemotherapy and prognosis. Methods Forty osteosarcoma patients from March 2000 to March 2004 confirmed by pathology and excluded metastasis by imaging were enrolled in this study,who were given one cycle chemotherapy of large dose of methotrexate,adriacin,cisplatin and ifosfamide.These patients were divided into two groups according to tumor necrosis rate（≥90% and90%）,and the postoperative lung metastasis rate and 5-year survival rate were compared. Results The patients in tumor necrosis rate≥90% and90% group were 23 cases and 17 cases.The 5-year survival rates in tumor necrosis rate≥90% and90% group were 78.3% and 23.5% and postoperative lung metastasis rate were 21.7% and 70.6% respectively,with statistical significances between the two groups（P〈0.05）. Conclusion Tumor necrosis rate is a direct and reliable method for evaluation of preoperative chemotherapy on osteosarcoma.Patients with tumor necrosis rate≥90% have lower metastasis and longer survival than whose tumor necrosis rate90%.