40岁以上成年骨肉瘤患者的外科治疗及预后因素

Surgical treatment and prognostic analysis of osteosarcoma in adults older than 40 years

目的:确定原发成人骨肉瘤患者的相关预后因素。方法:对1998年10月到2011年10月在北京大学人民医院骨肿瘤中心接收治疗的54例年龄超过40岁的成年骨肉瘤患者(其中男性24例,女性30例)的临床资料进行回顾性分析。结果:肿瘤位于肢体骨30例(55.5%)、中轴骨17例(31.5%)、骨外软组织7例(13%),6例患者(11.1%)在诊断时伴有其他部位转移,52例患者(96.3%)接受了手术治疗,14例患者局部复发(26.9%),21例患者(38.9%)诊断后出现转移。52例接受手术治疗的骨肉瘤患者5年的无病生存率和总体生存率分别为43.7%和50.4%。结论:造成成人骨肉瘤患者预后较差的因素很多,外科边界不充分、肿瘤更多来源于中轴部位、在诊断时已有远处转移以及肿瘤体积巨大,都与较差的生存率显著相关,积极地多元联合治疗有助于提高生存率。

Objective： To determine the prognostic factors of primary osteosarcoma in adults.Methods： This is a review of 54 patients older than 40 years（ 24 men and 30 women） who were treated between 1998 and 2011 at the authors＇ institution. Demographic information and follow-up data were obtained and statistically analyzed. Results： Tumors involved the limbs in 30 patients（ 55. 5%） and axial skeleton in 17 patients（ 31. 5%）,and arose from soft tissue in 7 patients（ 13%）. And 6 patients（ 11. 1%） had synchronous metastasis. According to our review,tumors were treated surgically in 52patients（ 96. 3%）. Local recurrence was documented in 14 patients（ 26. 9%）. Metastasis after diagnosis appeared in 21 patients（ 38. 9%）. In the 52 patients who received the surgical treatment,the 5 year disease-free survival and overall survival rates were 43. 7% and 50. 4%,respectively. Conclusion：Adult patients with primary osteosarcoma had a poor clinical outcome. Inadequate surgical margins,more tumors in the axial location due to high recurrence rates,metastatic disease at presentation,and large tumor volumes were associated with significantly lower survival rates. Aggressive multi-agent treatment regimens might improve survival.