颅底骨肉瘤的临床特点及治疗方法

Clinical features and comprehensive treatment of skull base osteosarcoma

目的探讨颅底骨肉瘤的临床特点和治疗方法。方法回顾性分析2005年1月至2013年11月间收治的18例颅底骨肉瘤患者的临床资料，通过电话、门诊复查等方式随访。15例患者获得随访，其中4例行单纯手术治疗，11例行手术治疗及辅助放化疗。生存分析采用Kaplan-Meier法和Logrank检验。结果15例获得随访的患者中，死亡9例，其中死于局部复发7例，死于远处转移2例，生存6例。4例单纯手术患者的中位生存时间为25．0个月，11例综合治疗患者的中位生存时间为47．0个月，差异有统计学意义（P=0．02）。5例肿瘤非完全切除患者的平均生存时间为47．0个月，10例肿瘤完全切除患者的平均生存时间为45．0个月，差异无统计学意义（P=0．37）。全组患者的1年复发率为46．6％，2年复发率为68．9％。全组患者的中位生存时间为30．0个月，1、2、3和5年生存率分别为82．4％、61．8％、36．0％和36．0％。结论颅底骨肉瘤患者的手术完全切除率低，复发率高，预后差，宜选用根治性手术为主的综合治疗。

Objective To analyze the clinical features and treatment of skull base osteosarcoma. Methods The clinical data of 18 patients with skull base osteosarcoma, who were admitted to the CAMS Cancer Hospital from January 2005 to November 2013, were retrospectively analyzed. The patients were followed up by telephone, outpatient review and other means. Fifteen patients were followed up, 4 cases received surgery only, and 11 cases received surgery with adjuvant chemotherapy and/or radiotherapy. Kaplan-Meier survival curve analysis was used to analyze the clinical data and Log rank method was used for verification. Results Nine patients died among the 15 patients who were followed up for 3-103 months （mean 25.0 months） ： seven patients died of local recurrence, and two patients died of distant metastasis, and six patients were still alive. Four patients received surgery only, with a median survival time of 25.0 months, and 11 patients received comprehensive treatment, with a median survival time of 47.0 months （P= 0.02）. Five patients received sub-total resection, with a mean survival time of 47.0 months, and 10 patients received total resection, with a mean survival time of 45.0 months （P= 0.37）. The 1- and 2-year recurrence rates were 46.6 % and 68.9%, respectively. The overall 1-, 2-, 3- and 5-year survival rates were 82.4%, 61.8%, 36.0% and 36.0%, respectively, with a median survival time of 30.0 months. Conclusions To compare the long bone and head and neck osteosareoma with skull base osteosarcoma, the skull base osteosarcoma has a lower total resection rate, a higher recurrence rate, and a poorer prognosis. Radical surgery and comprehensive treatment are appropriate for skull base osteosarcoma.