肢体原发成骨肉瘤综合治疗的远期结果

Long-term results of combined therapy for primary osteosarcoma in extrimities

目的 对肢体原发成骨肉瘤综合治疗及非综合治疗的结果进行比较和评估。 方法 术前无远处转移的肢体成骨肉瘤患者 170例 ,年龄 6～ 5 2岁 ,平均年龄 2 1岁 ,男性 112例 ,女性 5 8例 ;肿瘤部位 :股骨远端 80例 ,胫骨近端 5 1例 ,股骨近端 7例 ,肱骨近端 10例 ,四肢其它部位 2 2例。施行术前化疗 手术切除肿瘤 术后化疗综合治疗 (综合治疗组 ) 10 4例 ,单纯手术切除肿瘤 (非综合治疗组 )6 6例 ;行保留肢体手术 94例 ,其中施行化疗者 71例 ,未行化疗者 2 3例 ;行截肢术 76例 ,其中行化疗者 33例 ,未行化疗者 43例。 结果 5年生存率 :综合治疗组为 6 1% ,非综合治疗组为 2 8% ;10年生存率 :综合治疗组为 5 3% ,非综合治疗组为 2 6 % ;局部复发率 :综合治疗保肢组为 2 0 % ,截肢组为 3% ;非综合治疗保肢组为 44 % ,截肢组为 7% ;综合治疗组和非综合治疗组肺转移的发生率无明显差异。80例患者按照MSTS评分系统进行功能评定 ,其中保肢组 (5 6例 )平均分值为 71% ,截肢组 (2 4例 )平均分值为 5 3%。 结论 综合治疗可以提高骨肉瘤的存活率 ;肿瘤局部切除及重建手术可以为患者提供比较满意的肢体功能。

Objective[WT5”BZ] To evaluate the survival rates, functional outcome, and complications between the combined and non combined treatment of primary osteosarcoma of the extremities. [WT5”HZ]Method[WT5”BZ] From 1977 through 1992, 170 patients with high graded, nonmetastatic osteosarcoma were treated. Their average age at diagnosis was 21 years old (ranging from 6 to 52). Tumors were observed at distal femurs in 80 patients (47%), proximal tibia in 51 (30%), proximal humors in 10 and other locations in 22. Combined therapy (en bloc resection of tumor with preoperative and postoperative neoadjuvant chemotherapy) was givents 104 patients and non combined therapy (tumor resection only) to 66. Ninety four patients underwent limb salvage surgery. In 76 patients who received amputations or disarticulations 33 received chemotherapy. [WT5”HZ]Results[WT5”BZ] The 5 and 10 year survival rates were 61% and 53% in the combined therapy group and 28% and 26% in the noncombined therapy group. Local recurrence rate was 23% in limb salvage surgery group and 5.2% in amputation group. Functional evaluation of 80 patients showed that the patients who underwent salvage surgery had higher funcitional scores than those who had an amputation according to MSTS scoring system (1993). The average scores reached 71% in the salvage surgery group and 53% in the amputation group. [WT5”HZ]Conclusions[WT5”BZ] In this study, long term that combined therapy raised the survival rate of the patients with osteosarcoma. The ase of en bloc resection of bone tumor and reconstructive technique, has enade limb salvage procedures possible to produce excellent functional outcomes. The patients who well have respondes to preoperative chemotherapy may have a higher survival rate. [WT5”HZ]