骨肉瘤肺转移手术后的生存预测因素分析

Factors Predicting Survival of Osteosarcoma with Pulmonary Metastasis after Surgery

目的评估骨肉瘤患者肺部转移（PM）完全切除（CR）后的预后因素。方法回顾性分析62例转移性骨肉瘤患者接受治疗和随访的资料。单因素和多因素分析转移性骨肉瘤的人口统计学和疾病相关的特性对总体生存（OS）的影响。结果总共有25例PM患者行完全切除,并纳入分析。5年OS和无病生存率分别为30%和21%。单变量分析较差的OS相关的因素包括软骨细胞亚型,后化疗原发肿瘤坏死〈90%,新辅助或辅助化疗期间检测到转移,病理识别肿瘤细胞达到任何切除结节的内脏胸膜表面。在多变量分析中,软骨细胞亚型是唯一的独立的不良预后因素（HR=4.6,95%CI：1.0~21.3,P=0.044）。结论肿瘤生物学相关的因素,原发肿瘤坏死不彻底,化疗期间癌细胞转移,软骨细胞亚型和内脏胸膜受累都是手术预后差的相关因素。

Objective To study the prognostic factors of osteosarcoma with pulmonary metastasis after complete remission（ CR）. Methods Treatment and follow up data of 62 cases of osteosarcoma with pulmonary metastasis were retrospectively analyzed,univariate and multivariate analysis were used to analyze the effect of demographic and disease-related characteristics on overall survival（ OS）. Results 25 patients received CR were included in this analysis. 5-year OS and disease-free survival were were 30% and 21%,respectively. Univariate analysis showed that factors correlated with inferior OS were chondroblastic subtype,post-chemotherapy necrosis 〈90% in the primary tumor,metastasis detected during neoadjuvant or adjuvant chemotherapy and pathological identification of tumor cells reaching the visceral pleural surface of any of the resected nodules. In the multivariate analysis,the chondroblastic subtype was the sole independent adverse prognostic factor（ HR = 4. 6,95% CI： 1. 0 ~ 21. 3,P =0. 044）. Conclusion Therefore,factors associated with tumor biology,including poor tumor necrosis in the primary tumor,detection of metastasis during primary chemotherapy,chondroblastic subtype and visceral pleural are associated with poor prognosis.