影响骨肉瘤治疗预后效果的临床因素的研究进展

Research Progress of Clinical Prognostic Factors in Osteosarcoma

骨肉瘤是最常见的骨的原发性恶性肿瘤,常常好发于15-19岁。目前治疗上已经有了很大的进步,其最有效的治疗方案包括新辅助加上局部控制。但不幸的是,其治疗效果仍然非常低。因此在选择不同的治疗方式前需要对患者的预后进行严谨和科学的预测和判断,从而选择最佳的治疗方案。传统意义上影响骨肉瘤治疗预后效果的因素主要包括以下几点:年龄,性别,肿瘤大小,位置,分期和耐药性等。但是这些因素有着太多的测量和衡量方法,在不同的研究中进行统一标准下的比较是很难的。通常来讲,利用转移,耐药性等因素来进行预后的判断尽管能达到较高的准确性,但已经往往处于疾病的后期,对疾病治疗本身的意义不大。因此,需要去寻找新的,能够在早期对于预后进行判断,能够于早期进行准确的诊断从而进行早期治疗的方法。本文从位置,大小,年龄,分期,肿瘤的复发或转移,病理性骨折,手术和化学治疗等方面对骨肉瘤的预后及影响因素进行综述。

Osteosarcoma （OS） is the most common primary malignant neoplasm in adolescents, with a peak incidence at the age of 15-19 years. Advances in osteosarcoma therapy have enhanced patient outcomes. The most effective regimens currently include neoadjuvant and adjuvant chemotherapy coupled with local control. Unfortunately, the cure rate is still very poor due to pulmonary metastases. Therefore, it is necessary to have a rigorous and scientific forecast and judgment before the choice of different treatment in order to make a best outcome. Traditional prognostic determinants in osteosarcoma have included demographics （age, sex）, tumor size, site, stage, and the response to chemotherapy. Many of these are determined using varying techniques and units of measurement, which can make comparison between studies difficult. Commonly used prognostic determinants such as metastases, and response to chemotherapy enable a high degree of prognostic accuracy but usually at a late stage in the course of disease. Based on this, there is need to uncover new ways over osteosarcoma progression to facilitate more accurate diagnosis and earlier treatment. Here, the research progress of prognosis of osteosarcoma is reviewed from the aspects of tumor size, position, age, stage, recurrence or metastasis, surgery and chemotherapy.