儿童骨肉瘤的手术治疗及预后分析

Surgical treatment and prognosis analysis of osteosarcoma in children

目的探讨15岁以下儿童骨肉瘤的手术治疗方法以及治疗效果。方法回顾2003年6月至2011年12月我院治疗的15岁以下骨肉瘤患者共54例,男33例,女21例。按不同手术方式对其生存时间及术后并发症进行随访。同期随访15～25岁青少年骨肉瘤患者77例(男48例,女29例)作为对照,随访总例数为131例。在15岁以下儿童组中按手术方式分为截肢组(19例),假体置换组(8例)以及生物重建组(27例)。比较儿童组和青少年组之间整体生存率的差别,并比较不同手术方式之间儿童骨肉瘤患者预后的差异,应用Kaplan-Meier法计算患者生存率,应用Log-rank检验进行单因素分析,研究年龄因素以及手术方式与骨肉瘤患者生存率之间的关系。结果所有患者均获得随访,总的随访时间为4-77个月,平均39.7个月。Log-rank单因素统计分析显示儿童组和青少年组之间生存率差异有统计学意义(P=0.048<0.05),不同手术方式之间生存率差异无统计学意义,截肢组与似体置换组相比(P=0.962>0.05),截肢组与生物重建组(P=0.303>0.05),假体置换组与生物重建组(P=0.452>0.05)。结论本研究显示年龄可以作为骨肉瘤预后的影响因素,儿童骨肉瘤相对于青少年骨肉瘤来说,总体生存预后较差。对于儿童骨肉瘤手术治疗来说,不同的手术方式对其生存预后无明显影响。

Objective To investigate the surgical treatment methods and curative effects of osteosarcoma in children under the age of 15. Methods The clinical data of 54 patients with osteosarcoma under the age of 15 who were adopted by our hospital from June 2003 to December 2011 were retrospectively studied. Among them there were 33 males and 21 females treated by different surgical methods, whose survival time and postoperative complications were followed up. During the same period, 77 adolescent patients with osteosarcoma aging from 15 to 25 years old were followed up as the control group, among whom there were 48 males and 29 females. There were 131 patients who were followed up in total. The group of children under the age of 15 was divided into 3 subgroups： 19 cases in amputation group, 8 cases in prosthetic replacement group, and 27 cases in biological reconstruction group. The differences in overall survival rate between children group and adolescent group were compared, and the differences in prognosis of children patients with osteosareoma who were treated by different surgical methods were also compared. The Kaplan-Meier method was used to measure the survival rate. Log-rank test was used for univariate analysis, to study the relationship of the age factor and the surgical methods with the survival rate of the patients with osteosarcoma. Results AII patients were foIlowed up for 4-77 months, with an average period of 39.7 months. Log- rank univariate analysis showed that the differences in survival rate between children group and adolescent group were statistically significant （P=0.048〈0.05）. There were no statistically significant differences in survival rate for the patients who were treated by different surgical methods, when the comparison was carried out between amputation group and prosthetic replacement group （P=0.962〉0.05）, amputation group and biological reconstruction group （P=0.303〉0.05）, or prosthesis replacement group and biological reconstruction group （P=0.452〉0.05）. Conclusions According to this study, age can be a factor for osteosarcoma prognosis. The overall survival prognosis of children with osteosarcoma is worse than that of adolescent patients with osteosarcoma. There were no obvious effects on thesurvival prognosis when the children with osteosarcoma were treated by different surgical methods.