术后切口感染能延长骨肉瘤患者的生存期吗?

Can postoperative deep infections prolong survival time of osteosarcoma patients?

[目的]探讨保肢手术后切口深部感染对骨肉瘤患者生存的影响。[方法]回顾分析125例骨肉瘤患者临床资料,平均随访期为（5.1±3.9）年（0.5-19.8年）,对所得临床资料进行数据分析,并复习相关文献。[结果]共6例患者（4.8%）发生切口深部感染,无全身感染病例。感染和非感染患者接受化疗方案（P=1.00）及对化疗反应（P=0.65）的差异无统计学意义。感染组患者胫骨上段肿瘤较常见（4例,66.6%,P=0.04）,且多需截肢治疗（4例,66.6%,P=0.00）。感染患者肿瘤转移率（P=0.03）及死亡率（P=0.00）低于非感染者,差异具有统计学意义,生存分析提示感染组5年生存率及无瘤生存率均为100%,非感染组5年生存率及无瘤生存率分别为54%及43%。Log rank检验揭示感染患者总生存率（P=0.01）及无瘤生存率（P=0.01）均高于非感染者,差异具有统计学意义。COX回归分析提示肿瘤远处转移是患者预后的独立危险因素（P=0.00,95%CI 1.59-3.98）。[结论]保肢手术后感染可能对骨肉瘤患者预后产生积极影响,其机制可能是感染通过炎症免疫反应抑制肿瘤生长,具体的机制尚须进一步阐明,并在此基础上拓展骨肉瘤综合治疗的新方法,以期改善骨肉瘤患者的预后。

[Objective] To evaluate the effect of postoperative deep infection on survival time of osteosarcoma patients.[Methods] We reviewed the clinical records and relevant documentation of 125 osteosarcoma patients who were followed up for an average of（ 5. 1 ± 3. 9） years ranged from 0. 5 to 19. 8 years. [Results] Of them,6 patients（ 4. 8%） had chronic localized deep infection,however,none of them got systemic infection. Both the patients with and those without deep infection underwent same chemotherapeutic regimens（ P = 1. 00）,and similar histologic reactions（ P = 0. 65）. Compared to the patients without infection,the patients with deep infection trended to have the tumor more commonly localized in the proximal tibia（ P =0. 04）,and more frequently received amputations（ P = 0. 00） due to refractory infection. Five- year overall survival rate and tumor- free survival rate were both 100% in the infected patients,while 54% and 43% respectively in the non- infected patients,in which the differences between the two groups were of statistical significance（ Log- rank test： total survival,P =0. 01,tumor- free survival,P = 0. 01）. In addition,distant metastasis was an independent risk factor for prognosis determined by Cox regression analysis（ P = 0. 00,95% CI 1. 59 - 3. 98）. [Conclusion] Local deep infection after limb salvage surgery might have favorable effects on survival of the patients with osteosarcoma,which could be associated with the suppressive impact of inflammation on tumor. However,the exact mechanism remains to be furtherly researched to form a new therapeutic regimen for osteosarcoma.