新辅助化疗后肿瘤坏死率及碱性磷酸酶同工酶变化与预后的相关性研究

Research on tumor necrosis rate and changes of alkaline phosphatase in evaluating neoadjuvant chemotherapy of osteosarcoma

目的探讨骨肉瘤患者新辅助化疗后的肿瘤坏死率(TCNR)及碱性磷酸酶骨同工酶(BALP)变化与预后的关系。方法选取2003年1月至2007年3月初诊经活检病理诊断为骨肉瘤且排除转移的58例患者,术前常规新辅助化疗,根据对手术切除肿瘤标本的TCNR测定将患者分为两组(TCNR≥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。同时检测患者在化疗前后及随访期间血清中BALP,并对检测结果进行分析。结果 58例骨肉瘤患者中TCNR≥90%组为36例,<90%组为22例,两组的术后肺转移率分别为16.7%和81.8%(X^2=12.156,P<0.01),5年生存率分别为72.2%和22.7%(X^2=8.125,P<0.01)。化疗后BALP的下降比值与TCNR的升高呈正相关(r=0.735,P<0.01)。随访期间肿瘤复发转移组与无瘤生存组BALP水平上差异有统计学意义(P<0.01)。结论 TCNR测定是评价骨肉瘤新辅助化疗反应较可靠方法,TCNR≥90%患者的远期转移率和生存时间明显优于TCNR<90%患者。BALP是骨肉瘤血清学检查的高灵敏度指标,在骨肉瘤的治疗监测和预后的判断上有很高价值。TCNR和BALP两者同时检测可以提高预后精确性。

Objective To discuss the relationship of prognosis and tumor necrosis rate（TCNR） as well as changes of alkaline phosphatase bone isoenzyme in neoadjuvant chemotherapy for osteosarcoma. Methods From January 2003 to March 2007, 58 patients were diagnosed as osteosarcoma by biopsy histopathologie diagnosis and distant metastases were excluded by imaging examintaion. All of them were given conventional preoperative neoadjuvant chemotherapy, TCNR were tested in surgical resection specimens and the patients were divided into two groups according to the results （TCNR I〉 90% and 〈 90% ）. The two groups were followed up for postoperative lung metastasis and 5-year survival rate, which were compared. The serum levels of BALP were also detected before treatment after treatment and during follow-up. All the results were compared. Results TCNR of 36 cases ≥ 90% , and TCNR of 22 cases 〈 90%. Postoperative lung metastasis rates of two groups were 16.7% and 81.8% （x2 = 12. 156, P 〈 0. 01 ） respectively; 5-year survival rates were 72. 2% and 22. 7% （x2 = 8. 125, P 〈 0. 01 ） respectively. The reduced ratio of BALP and increased TCNR after chemotherapy were positively correlated （ r = 0. 735, P 〈 0. 01 ）. During follow-up, BALP level was statistically significant in tumor-recurrence group and disease-free survival group （P 〈 0. 01 ）. Conclusions TCNR is a direct and reliable index for evaluation of neoadjuvant chemotherapy on osteosarcoma. Patients with TCNR ≥ 90% have lower metastasis and better survival rate than those whose TCNR 〈 90%. BALP is a highly sensitive serum index of osteosarcoma, and is valuble for treatment monitoring and prognosis of osteosarcoma. Both detecting TCNR and BALP can improve the accuracy of prognosis.