骨肉瘤肺转移患者的外科手术治疗及生存分析

Surgical treatment on osteosarcoma with pulmonary metastases and survival analysis

背景与目的:骨肉瘤术后肺转移常见,肺转移瘤切除术治疗各种恶性肿瘤肺转移的疗效上已得到肯定。本研究探讨肺转移瘤切除术治疗骨肉瘤肺转移的可行性,分析接受了手术治疗的骨肉瘤肺转移患者生存状况与其临床资料关系,以筛选适合的患者接受肺转移瘤切除术。方法:通过电话随访方式了解29例骨肉瘤转移患者在上海交通大学附属第六人民医院接受肺转移瘤切除手术后的生存状况。总结这组患者的临床资料,使用Kaplan-Meier法绘制生存曲线,并采用log-rank检验比较这组患者在一般临床特征、转移瘤数目及类型、外科治疗方式因素下的生存曲线差异状况。通过COX回归模型研究这些因素与患者生存的关系。结果:29例骨肉瘤肺转移患者2年生存率为46.52%。手术期间无死亡病例,无严重并发症出现。肺转移瘤数目≤3的患者与>4的患者之间的生存曲线差异有统计学意义(P<0.05)。患者的一般临床资料、转移瘤类型与外科手术切除方式对患者的生存状况影响差异无统计学意义(P>0.05)。胸腔镜手术与开胸手术对患者的生存状况影响差异无统计学意义(P>0.05)。多因素回归分析显示,肺转移瘤数目是影响预后的独立因素(P=0.041)。结论:肺转移瘤切除术对于骨肉瘤肺转移患者具有可以接受的手术后风险。不同转移瘤数目对骨肉瘤肺转移的生存时间有影响。不推荐胸腔镜作为骨肉瘤肺转移的治疗选择。

Background and purpose： The pulmonary metastases is the common phenomenon in the osteosarcoma after operation. The effect of lung metastasectomy in other malignant tumors has been confirmed. This study was to investigate the possibility of surgery treatment to lung metastases of osteosarcomas, to analyze the relationship of living state and the clinic data of these patients that may help to select suitable patients for pulmonary metastasectomy. Methods： Follow-up by telephone to know the living state of 29 osteosarcoma patients with lung metastasectomy. The clinic data of these patients and draw the survival curve by Kaplan-Meier was summarized. And the difference of survival curve in clinic feature, the number and type of metastatic tumor, as well as type of surgical resection, and study these influencing factors with existence using the multivariate COX regression was analyzed. Results： The 2-year survival rate was 46.52%. NO perioperative deaths and serious complication occurred. The survival difference was significant between patients with the number of metastates ~〈 3 and the number of metastates〉4 （1~〈0.05）. There was no significant difference in clinic data, the type of metastatic tumor and the type of surgical resection （P〉0.05）. There was also no significant difference between thoracosopy and thoracotomy （P〉0.05）.Multivariate regression analysis showed that the number of metastasis lesions was independent prognostic factor （P=0.041）. Conclusion： The risk ofpostoperation of surgery treatment to osteosarcoma patients with lung metastates can be accepted. The number of metastaes affected the survival time of osteosarcoma patients with lung metastates and could improve the prognosis of patients. Thoracoscopy was not recommendation for metastasectomy to lung metastates of osteosarcoma.