老年骨肉瘤10例治疗总结

Osteosarcoma in elderly patients: a report of 10 cases

目的探讨老年骨肉瘤(≥60岁)的临床特点和治疗效果。方法回顾性分析2007年1月至2017年3月期间山东大学齐鲁医院骨科收治的≥60岁的骨肉瘤患者10例,女性8例,男性2例,年龄60～76岁,平均(66±6)岁,病变位于股骨5例、踝关节软组织1例、多中心1例、骨盆(Ⅲ区)1例、肱骨1例、距骨1例。确诊后行截肢术2例,截肢术结合化疗2例,广泛切除术1例,广泛切除术结合化疗3例,边缘切除结合放疗1例,单纯化疗1例。结果 10例患者中,4例就诊时病史已超过6个月,2例就诊时已出现肺转移,5例合并基础疾病,2例血清ALP水平升高(>125 U/L)。影像学方面,7例为混合型,1例为溶骨型,1例为成骨型,1例位于软组织。肿瘤组织类型方面,普通型骨肉瘤7例,骨旁骨肉瘤2例,髓内高分化性骨肉瘤1例。10例患者随访3.5～124个月,平均(40±37)个月。1例接受单纯化疗的肺转移患者于明确诊断后3.5个月死亡,另1例肺转移患者接受转移灶射频消融术,随访58个月带瘤生存,1例距骨骨肉瘤复发后行截肢术。其余7例均未出现肿瘤复发或远处转移。结论老年骨肉瘤临床较为少见,具有不同于青少年骨肉瘤的临床特点和预后,应早期明确诊断,采取适合患者自身情况的治疗方法,以尽可能降低复发和转移的发生率,延长生存期。

Objective To investigate the clinical features and therapeutic effect of osteosarcoma in elderly patients(older than 60 years). Methods Ten cases of osteosarcoma older than 60 years in Qilu Hospital of Shandong University from January 2007 to March 2017 were analyzed retrospectively. There were eight females and two males, with a mean age of 66±6 years(range: 60-75 years). The tumor occurred at femur in five cases, one case at soft tissue of ankle, one case at multiple sites, pelvis in one case, humerus in one case and astragalus in one case. Among the ten cases, two cases received amputation, two cases received amputation and chemotherapy, one case received wide resection, three cases received wide resection and chemotherapy, one case received marginal resection and radiotherapy and one case only received chemotherapy.Results The duration from presentation was more than 6 months in four cases. Two cases had lung metastasis before diagnosis. In addition, five cases had comorbidity and the level of ALP in serum was high(>125 U/L)in two cases. Based on imaging examination, seven cases showed a mixture of osteosclerotic and osteolytic lesions, one case showed osteolytic lesion, one case showed osteosclerotic lesion and one case had soft tissue lesion. Histologically, there were seven cases of conventional osteosarcoma, two cases of parosteal osteosarcoma and one case of well-differentiated intraosseouso steosarcoma. Ten cases were followed up for an average period of 40±37 months(range: 3.5-124 months). One case with lung metastasis only received chemotherapy died 3.5 months after diagnosis. One case with lung metastasis treated with radiofrequency ablation survived 58 months after diagnosis. One case underwent amputation after recurrence in astragalus. There was no recurrence or metastasis in the other seven patients. Conclusion Osteosarcoma in elderly patients is rare and distinct from osteosarcoma in adolescents in term of clinical features and prognosis. It should be early diagnosed and appropriately treated to decrease the rate of recurrence and metastasis and to improve the overall survival.