新辅助化疗联合保肢手术治疗骨肉瘤的疗效分析

Therapeutic effect of neoadjuvant chemotherapy combined with Limb salvage surgery for osteosarcoma

目的探讨新辅助化疗联合保肢手术治疗骨肉瘤的疗效。方法选取2002年7月—2010年1月新乡医学院第一附属医院收治的骨肉瘤患者78例,按照随机数字表法分为观察组和对照组,每组39例。观察组接受新辅助化疗联合保肢手术治疗,对照组仅接受保肢手术治疗。采用逆转录聚合酶链反应(RT-PCR)检测术中肿瘤组织的microRNA表达;采用酶联免疫吸附试验(ELISA)检测血清肿瘤标志物含量;随访记录无进展生存时间(PFS)、总生存时间(OS)及5年生存率。结果观察组术中肿瘤标本组织中的microRNA-145、microRNA-101、microRNA-335、microRNA-365表达高于对照组(P<0.05);术后4周,观察组血清碱性磷酸酶(ALP)、乳酸脱氢酶(LDH)、血管内皮生长因子(VEGF)、碱性成纤维生长因子(bFGF)含量低于对照组(P <0.05);随访期间,观察组PFS、OS时间长于对照组,5年生存率高于对照组(P <0.05)。结论新辅助化疗联合保肢手术可抑制骨肉瘤组织恶性分子表达,增强手术治疗效果,优化远期治疗结局。

Objective To investigate the therapeutic effect of neoadjuvant chemotherapy combined with Limb salvage surgery for osteosarcoma.Methods Seventy-eight cases of osteosarcoma in The First Affiliated Hospital of Xinxiang Medical University from July 2002 to January 2010 were divided into observation group and control group according to the random number table method,39 cases in each group.Patients in observation group received neoadjuvant chemotherapy combined with limb salvage surgery and those in control group only received limb salvage surgery.Reverse transcription polymerase chain reaction(RT-PCR)was used to detect the expression of miRNA in tumor tissues.Serum tumor markers were detected by enzyme-linked immunosorbent assay(ELISA).The progression-free survival time(PFS),overall survival(OS)and 5-year survival rate were recorded.Results The expression of miRNA-145,miRNA-101,miRNA-335 and miRNA-365 in the tumor tissues of the observation group was higher than that of the control group(P<0.05).After 4 weeks,the serum alkaline phosphatase(ALP)was observed in the observation group.The levels of lactate dehydrogenase(LDH),vascular endothelial growth factor(VEGF)and basic fibroblast growth factor(bFGF)were lower than those of the control group(P<0.05).During the follow-up period,the PFS and OS time in the observation group were longer than those in the control group.The 5-year survival rate was higher than that of the control group(P<0.05).Conclusions Neoadjuvant chemotherapy combined with limb salvage surgery can inhibit the expression of malignant molecules in osteosarcoma,enhance the effect of surgical treatment,and optimize the outcome of long-term treatment.