躯干中轴部位局限期尤文氏肉瘤家族肿瘤的综合治疗效果分析

Efficacy analysis of comprehensive therapy on localized Ewing's sarcoma family of tumors in the trunk axis

目的探讨躯干中轴部位尤文氏肉瘤家族肿瘤(ESFT)的临床特点及治疗策略。方法从新疆医科大学附属肿瘤医院2008年1月至2017年5月收治的发生于躯干中轴部位的79例局限期ESFT患者中,筛选出有完整随访资料者67例;根据治疗方式分为综合治疗组39例(化疗+手术+放疗15例、化疗+手术12例及化疗+放疗12例)和单一治疗组28例(化疗10例、手术12例及放疗6例),采用RECIST 1.1版标准评价近期疗效,根据随访资料分析远期生存情况。结果综合治疗组的有效率为76.9%(30/39),高于单一治疗组的50.0%(14/28),差异有统计学意义(P<0.05);综合治疗组的中位总生存期(OS)和无事件生存期(EFS)分别为57.0个月和36.0个月,优于单一治疗组的19.0个月和8.0个月,差异有统计学意义(P<0.05)。39例综合治疗者中27例接受手术+放疗+化疗或手术+放疗的有效率、中位OS和EFS分别为81.5%(22/27)、48.0个月和32.0个月,优于12例接受化疗+放疗的66.7%(8/12)、38.0个月和23.5个月,差异有统计学意义(P<0.05)。39例综合治疗者中24例接受阿霉素联合异环磷酰胺(ADM+IFO)方案的有效率为62.5%(15/24),与其余15例(非ADM+IFO方案)的73.3%(11/15)相比,差异无统计学意义(P>0.05);24例接受ADM+IFO方案的中位OS和EFS均>64.0个月,与其余15例(非ADM+IFO方案)的58.0个月和34.0个月相比,差异亦无统计学意义(P>0.05)。结论综合治疗能改善发生在躯干中轴部位局限期ESFT患者的疗效和生存。化疗、手术联合放疗的治疗模式在疗效和生存方面优于化疗联合放疗模式。

Objective To investigate the clinical characteristics and treatment strategies of the Ewing s sarcoma family tumor(ESFT)in the trunk axis.Methods From January 2008 to May 2017,67 cases with complete follow-up data were selected from 79 patients with localized ESFT in the trunk axis in Affiliated Tumor Hospital of Xinjiang Medical University.According to the treatment,67 cases were divided into comprehensive therapy group(n=39;including 15 cases of chemotherapy+surgery+radiotherapy,12 cases of chemotherapy+surgery and 12 cases of chemotherapy+radiotherapy)and simple therapy group(n=28;including 10 cases of chemotherapy,12 cases of surgery and 6 cases of radiotherapy).The short-term efficacy was evaluated by RECIST 1.1,and long-term survival was analyzed based on follow-up data.Results The effective rate of the comprehensive therapy group was 76.9%(30/39),higher than 50.0%(14/28)of the simple therapy group,and the difference was statistically significant(P<0.05).The median overall survival(OS)and event-free survival(EFS)in the comprehensive therapy group were 57.0 months and 36.0 months,better than 19.0 months and 8.0 months of the simple therapy group(P<0.05).Among the 39 patients with comprehensive treatment,the effective rate,median OS and EFS were 81.5%(22/27),48.0 months and 32.0 months in 27 cases receiving surgery+radiotherapy+chemotherapy or surgery+radiotherapy,all higher than 66.7%(8/12),38.0 months and 23.5 months in 12 cases receiving radiotherapy+chemotherapy(P<0.05).Among the 39 cases of comprehensive treatment,the effective rate of 24 patients receiving adriamycin combined with ifosfamide(ADM+IFO)regime was 62.5%(15/24),similar with 73.3%(11/15)of the remaining 15 patients(non-ADM+IFO)(P>0.05).The median OS and EFS of 24 patients receiving ADM+IFO regime were both>64.0 months,similar with 58.0 months and 34.0 months of other 15 patients(P>0.05).Conclusion Comprehensive therapy can improve the efficacy and survival of patients with ESFT in the central axis of the trunk.Chemotherapy and surgery combined with radiotherapy are superior to chemotherapy combined with radiotherapy in the treatment and survival.