骨肉瘤误诊误治30例的临床特征及预后分析

Retrospective analysis of clinical characteristics and prognosis of 30 patients misdiagnosed and mistreated for osteosarcoma

目的:比较误诊误治骨肉瘤患者与正确诊断和治疗骨肉瘤患者的临床特征和预后差异。方法:回顾性分析2007年1月-2010年2月共30例误诊误治骨肉瘤患者与60例正确诊断和治疗骨肉瘤患者的临床资料,并对预后进行随访,随访时间为6～60个月。比较2组患者年龄、性别、肿瘤部位、Enneking外科分期、Karnofsky体能状况(Karnofsky performance status,KPS)评分、病理类型、手术方式、肿瘤最大径、肿瘤坏死率、辅助化疗周期数、局部复发率和肺转移率的差异。应用Kaplan-Meier法计算2年生存率。结果:2组患者的性别、Enneking外科分期、KPS评分、肿瘤部位、病理类型、手术方式、辅助化疗周期数、局部复发时间和肺转移时间的差异无统计学意义(P>0.05)。误诊误治组发病年龄≥30岁的比例(分别为46.7%和11.7%,P<0.001)、肿瘤最大径≥10cm的比例(分别为50.0%和23.3%,P=0.011)、肿瘤坏死率<90.0%的比例(分别为80.0%和60.0%,P=0.016)、局部复发率(分别为33.3%和10.0%,P=0.006)和肺转移率(分别为63.3%和43.3%,P=0.037)均较正确诊断和治疗组高。误诊误治组患者的中位生存时间为25.5个月(95%可信区间为7.1～58.9个月),正确诊断和治疗组患者的中位生存时间为38.0个月(95%可信区间为12.2～55.0个月),差异有统计学意义(P=0.025)。正确诊断和治疗组患者的2年生存率(83.3%)明显高于误诊误治组(63.3%)(P=0.036)。结论:年龄≥30岁的骨肉瘤患者易被误诊为良性疾病,对骨肉瘤的误诊误治可导致较高的局部复发率和肺转移率,并缩短生存期。

Objective：To compare the clinical characteristics and prognosis between the misdiagnosed and mistreated patients and the correctly diagnosed and treated patients with osteosarcoma. Methods：The clinical records of patients with osteosarcoma who received misdiagnosis and unplanned therapy （n = 30） and those who received correct diagnosis and therapy （n = 60） between January 2007 and February 2010 were retrospectively reviewed. The follow-up time was 6-60 months. The factors including gender, age, tumor location, Enneking’s surgical staging, Karnofsky performance status score, pathological type, surgical procedure, tumor size, tumor necrosis rate, frequency of adjuvant chemotherapy, local recurrence rate, and lung metastasis rate were compared between the two groups. The two-year survival rate was calculated by Kaplan-Meier method. Results：No significant differences between the two groups were found in terms of gender, Enneking’s surgical staging, Karnofsky performance status score, tumor location, pathological type, surgical procedure, frequency of adjuvant chemotherapy, time to local recurrence and time to lung metastasis （P 〉 0.05）. The proportions of patients aged 30 years or more （46.7% vs 11.7%, P 〈 0.001）, having a tumor’s diameter of 10 cm or more （50.0% vs 23.3%, P = 0.011）, and having tumor necrosis rate lower than 90.0% （80.0% vs 60.0%, P = 0.016） were significantly higher in the misdiagnosed and mistreated group than in the correctly diagnosed and treated group. The local recurrence rate （33.3% vs 10.0%, P = 0.006） and the lung metastasis rate （63.3% vs 43.3%, P = 0.037） in the misdiagnosed and mistreated group were also significantly higher than those in the correctly diagnosed and treated group. The median survival time and the two-year survival rates of the misdiagnosed and mistreated group and the correctly diagnosed and treated group were 25.5 （95% confidence interval：7.1-58.9） months and 38.0 （95% confidence interval：12.2-55.0） months, and 83.3% and 63.3%, respectively （P = 0.025; P = 0.036）. Conclusion：The patients with osteosarcoma aged 30 years or more were more likely misdiagnosed as having benign diseases. Misdiagnosis and unplanned therapy for osteosarcoma can result in higher local recurrence rate and lung metastasis rate as well as a poor prognosis.