高危骨肉瘤的临床特点及治疗对策

Characteristics of high-risk osteosarcoma and treatment countermeasure

目的 通过分析 6 1例骨肉瘤预后因素及生存率 ,探讨高危骨肉瘤临床特点及治疗对策 ,报告 16例高危骨肉瘤治疗经验 .方法 以经肢体挽救手术治疗有完整随访资料的6 1例骨肉瘤为基础 ,寿命表法计算生存率 ,采用图像分析技术对肿瘤预后相关因素包括肿瘤的绝对长度、绝对宽度、绝对深度、绝对面积、软组织肿块最大横径进行分析 .结果 6 1例骨肉瘤随访 1～ 10 a,5 a生存率 5 7.5 % ,外科分期 III期 ;骨肉瘤与宿主骨面积比≥ 2 / 3;软组织肿块最大横径≥ 6 cm;病理骨折 ;活检标本 PCNA阳性细胞检出占平均视野 2 / 3以上均属高危骨肉瘤 .采用术前多次化疗 ,深静脉持续给药 ;高选择骨肉瘤原发灶和转移灶滋养动脉化疗并栓塞 ;术前放疗和肢体挽救术处理高危骨肉瘤 16例 ,随访 1.5 a,死亡 2例 ,带病存活 5例 ,无病存活 9例 ,保肢率 6 8.7% .结论 本研究使一些高危骨肉瘤得到了积极救治 ,更具备综合性和肿瘤针对性 .

AIM We discussed the characteristics and treatment of high risk osteosarcoma by analyzing prognostic factor and survival rate of 61 osteosarcoma patients, and reported some experience. METHODS Depending on 61 osteosarcoma patients who undertook limb salvage operation and had integrity following up data, we adopted image analyzing technology to process the prognostic factors, which included absolute tumor length, width, depth, area and maximum transverse diameter. RESULTS 61 osteosarcoma cases had been followed up for 10 years. Five year survival rate was 57.5%. The high risk factors included III surgery stage, higher than 2/3 area ratio of sarcoma to host bone, more than 6 centimeters maximum transverse diameter, pathological fracture, and higher than 2/3 positive area per sight scope of PCNA in biopsy specimen. Then we undertook repeated pre operation chemotherapy, high selective artery embolism and chemotherapy, and salvage procedures for 16 high risk osteosarcoma patients, there were 2 death, 5 survival with tumor and 9 non tumor survival after 18 months following up, and the successful salvage rate was 68.7%. CONCLUSION Our research leads the active treatment to high risk osteosarcoma, aims directly at the osteosarcoma and provides comprehensive treatment project.