骨肉瘤肺转移患者不同治疗方法的生存分析

Survival analysis of osteosarcoma patients with pulmonary metastasis undergoing different therapeutic methods

目的 :分析针对骨肉瘤肺转移病灶的不同治疗方法与患者预后的关系。方法 :回顾性分析2006年1月—2011年8月收治并随访的骨肉瘤肺转移患者87例,根据肺转移病灶治疗方法的不同分为外科手术联合全身化疗组(21例)、伽玛刀联合全身化疗组(26例)和单纯全身化疗组(40例),Kaplan-Meier法分析患者的生存情况,并对预后进行单因素和多因素分析。结果 :外科手术联合全身化疗组和伽玛刀联合全身化疗组患者的中位无进展生存期(8和6个月)均长于单纯全身化疗组(3个月)(P均<0.01),3组患者的3年生存率分别为38.10%、30.77%和12.50%。单肺与双肺转移、初治与复治、肺部转移灶的数目及分布类型、肺以外其他部位转移及肺部转移灶的治疗方法与骨肉瘤肺转移患者的预后有关(P<0.05)。肺转移灶的治疗方法是影响患者预后的独立因素(P<0.05)。结论 :外科手术联合全身化疗或伽玛刀联合全身化疗可提高骨肉瘤肺转移患者的疗效。

Objective： To analyze the relationship between the prognosis and the different therapeutic methods in osteosarcoma patients with pulmonary metastasis. Methods： The clinical data of 87 osteosarcoma patients with pulmonary metastasis admitted in Sixth People’s Hospital from January 2006 to August 2011 were retrospectively reviewed. All patients were followed up. According to the different therapeutic methods for the metastatic lung lesions, these 87 patients were divided into three groups： surgery combined with chemotherapy group（21 cases）, gamma-knife radiosurgery combined with chemotherapy group（26 cases）, and chemotherapy alone group（40 cases）. Kaplan-Meier method was used for survival analysis. The prognosis-related factors were analyzed by univariate and multivariate analyses. Results： The median progression-free survival（PFS） of patients in surgery combined with chemotherapy group or gamma-knife radiosurgery combined with chemotherapy group（8 months and 6 months） was longer than that in the chemotherapy alone group（3 months）（both P 〈 0.01）. Three-year survival rates of osteosarcoma patients in surgery combined with chemotherapy group, gamma-knife radiosurgery combined with chemotherapy group, and the chemotherapy alone group were 38.10%, 30.77% and 12.50%, respectively. The unilateral or bilateral lung metastasis, initial treatment or retreatment, the number and distribution type of lung metastatic lesions, metastases of other sites（not lung）, and the therapeutic methods for the lung lesions were correlated with prognosis（P 〈 0.05）. The therapeutic method for lung metastatic lesions was an independent prognostic factor（P 〈 0.05）. Conclusion： Chemotherapy combined with surgery or gamma-knife radiosurgery can effectively improve the survival of osteosarcoma patients with lung metastasis.