上颌骨不同病理亚型软骨肉瘤治疗方案的系统评价

Systematic evaluation of different pathological subtypes of chondrosarcoma in maxilla

目的探讨上颌骨不同病理亚型软骨肉瘤的治疗方案及预后。方法检索PubMed收录文献中有详细记录病理检查及治疗的上颌骨软骨肉瘤个案报道,对纳入的研究进行质量评价和数据提取。最后纳入统计分析案例共63例。统计采用SPSS20.0软件,统计数据以中位数表示,统计每位患者的年龄、性别、病程、治疗、复发、转移、随访,对随访的生存时间进行异质性检测,采用RenMan 5.0统计学软件进行分析。结果个案报道中共4种病理亚型,依次为间叶性软骨肉瘤44例、黏液性软骨肉瘤6例、透明细胞软骨肉瘤及未分化软骨肉瘤各1例,只按病理系统分级分类11例。病理分型与分级是决定选择不同手术术式及放化疗的重要因素;间叶性软骨肉瘤应用单纯手术、手术+放射、手术+化疗、手术+放射+化疗方案的中位生存时间分别是6.21年(95%CI:2.51～9.91,P=0.003)、9.17年(95%CI:3.01～15.33,P=0.010)、3.50年(95%CI:-1.43～4.83,P=0.128)、8.50年(95%CI:-10.91～27.91,P=0.258);黏液性软骨肉瘤应用单纯手术、手术+放射方案的中位生存时间分别是2.50年、0.4年;透明细胞软骨肉瘤应用单纯手术中位生存时间是10年。结论间叶性软骨肉瘤应用手术+放射的治疗效果最好,中位生存时间超过9年;黏液性软骨肉瘤应用单纯手术的治疗效果较好。

Objective To explore the treatment and prognosis of different pathological subtypes of chondrosarcoma in maxilla.Methods PubMed database reports that presented detailed pathological examination and treatment for chondrosarcoma in maxilla were retrieved for data extraction and quality evaluation.63 cases were included for statistical analysis.Statistical analysis using SPSS 20.0 software was performed.The following data were extracted from each article:age,gender of the patients,illness course,treatment regimen,recurrence status,metastasis,and following-up.The heterogeneity of survival time was also evaluated by RenMan 5.0 statistical software.Results There were 4 pathological subtypes in the case reports with 44 cases of mesenchymal chondrosarcoma,6 cases of mucinous chondrosarcoma,and 1 case of clear-cell chondrosarcoma and 1 case of undifferentiated chondrosarcoma,respectively.Pathological classification and grading are important factors for determining different surgery procedure,radiotherapy and chemotherapy.The median survival time of mesenchymal chondrosarcoma with simple surgery,surgery+radiation,surgery+chemotherapy,surgery+radiation+chemotherapy was 6.21(95%CI:2.51-9.91,P=0.003),9.17(95%CI:3.01-15.33,P=0.01),3.5(95%CI:-1.43-4.83,P=0.128)and 8.50(95%CI:-10.91-27.91,P=0.258)years,respectively.The median survival time of mucinous chondrosarcoma with simple surgery,surgery+radiation was 2.5 and 0.4 years,respectively.The median survival time of clear-cell chondrosarcoma with a simple surgery was10 years.Conclusion Surgery+radiation is the best treatment for mesenchymal chondrosarcoma and provides patients with an median survival time of over 9 years.Simple surgery is treatment for mucinous chondrosarcoma with best effects.