43例骨肉瘤患者预后的多因素分析

Multivariate analysis for prognostic factors among 43 patients with osteosarcoma

目的:探讨影响骨肉瘤患者预后的相关因素。方法:回顾性分析2005年3月至2007年3月手术治疗并经病理证实的43例骨肉瘤患者的临床资料,包括性别、年龄、部位、病程、化疗前血清碱性磷酸酶水平、术前化疗、En-neking分期、手术方式及远处转移情况等9项相关因素,采用Kaplan-Meier法计算生存率,应用Log-rank检验行单因素分析,COX检验行多因素分析,研究这些因素与骨肉瘤患者3年生存率之间的关系。采用精确概率Fisher检验研究化疗疗效对骨肉瘤患者预后的影响。结果:43例均获随访,28例存活,15例死亡,生存时间6～65个月,平均39.7个月,中位生存时间42个月,3年总生存率65.1%。单因素分析显示,骨肉瘤预后与部位(P=0.010)、Enneking分期(P=0.002)、手术方式(P=0.000)、远处转移(P=0.002)有相关性;COX多因素分析显示Enneking分期(P=0.028)、手术方式(P=0.001)及远处转移(P=0.007)是影响骨肉瘤患者预后的独立因素。Fisher精确检验显示,尽管术前是否行新辅助化疗对预后影响不明显,但是新辅助化疗疗效的好坏是患者预后的重要影响因素(P=0.007)。结论:骨肉瘤预后与En-neking分期、手术方式及远处转移密切相关,早期发现及充分切除肿瘤是提高骨肉瘤预后可干预措施。

Objective：To determin the prognostic factors that influence survival in patients with osteosarcma.Methods：The clinical data of 43 patients with osteosarcoma between March 2005 and March 2007 were retrospectively reviewed.Patient＇s sex,age,tumor site,course of disease,serum alkaline phosphatase （AKP） level,preoperative chemotherapy,Enneking surgical stage,surgical method,distant metastasis were analyzed by Kaplan-Meier method,Log-rank test and COX regression model.Kaplan-Meier method was used to calculate the 3-years survival rate,and Log-rank test was used to determin prognostic factors related with survival rate,and COX regression model was used to find the independent prognostic factors.The effect of neoadjuvant chemotherapy on the prognosis of osteosarcoma was analyzed by Fisher exact test.Results：All the patients were followed up.Twenty-eight patients were alive,while 15 patients were dead.The survival time ranged from 6 to 65 months with a median survival of 42 months.Overall 3-year survival rate was 65.1%.Univariate analysis revealed that the prognosis of osteosarcoma was significantly related to tumor site （P=0.010）,Enneking surgical stage （P=0.002）,surgical method （P=0.000） and distant metastasis （P=0.002）.Multivariate analysis by COX regression model suggested Enneking surgical stage （P=0.028）,surgical method （P=0.001） and distant metastasis （P=0.007） were the independent prognostic factors.Though the preoperative chemotherapy was unrelated to the survival of osteosarcoma,the sensitivity to preoperative chemotherapy was an important factor that affected the prognosis of osteosarcoma （P=0.007）.Conclusion：The prognosis of osteosarcoma was significantly correlated with Enneking surgical stage,surgical method and distant metastasis,early detection and wide excision were interventional methods to improve the survival of osteosarcoma.