新辅助化疗联合手术治疗骨肉瘤的长期效果分析

Long-term Efficacy Analysis of Osteosarcoma Treatment with Neoadjuvant Chemotherapy Combined Surgery

目的:通过平均10年随访分析新辅助化疗联合手术治疗骨肉瘤(osteosarcoma,OS)的临床预后。方法:收集2005年1月-2010年4月在福建医科大学附属第一医院被诊断为OS的患者资料,包括性别、年龄、外科分期、病理分型、影像学资料等。纳入病理确诊骨肉瘤,采用多柔比星(ADM)、顺铂(DDP)和异环磷酰胺(IFO)联合化疗(术前1+术后6疗程),随访资料完整的患者。结果:纳入44例患者,男25例,女19例,年龄12~74岁,中位年龄18岁,平均(23.68±12.82)岁。目前随访时间97~162个月,平均(121.36±15.46)个月,超过10年。总的来说,生存率为43.19%(19/44),中位生存期为27个月,平均生存期为(64.07±52.36)个月(6~162个月)。总体死亡25例,发生在初诊1、3、5、10年内的分别占44%(11/25)、88%(22/25)、96%(24/25)和100%(25/25)。病程中发生转移高达65.91%(29/44),发生在初诊即刻、1、3、5、10年内的分别为13.79%(4/29)、75.86%(22/29)、96.55%(28/29)、100%(29/29)和100%(29/29)。转移型和非转移型患者10年生存率分别为31.03%(9/29)和66.7%(10/15),差异有统计学意义(P<0.000)。结论:采用新辅助化疗联合手术治疗后,OS患者平均随访10年生存率较短期随访显著降低,而转移率无明显变化;转移和死亡的发生主要集中在初诊的3年内,转移型患者的死亡率显著高于非转移型患者。

Objective:To analyze the clinical prognosis of osteosarcoma(OS) after treatment with neoadjuvant chemotherapy combined surgery through 10 years follow-up.Method:The data of patients diagnosed with OS in The First Affiliated Hospital of Fujian Medical University from January 2005 to April 2010 were collected,including gender,age,surgical staging,pathological classification and imaging material.Inclusion criteria:pathological diagnosis as osteosarcoma, had been treated with chemotherapy(ADM,CP and IFO) a period before surgery and 6 period after,and follow-up data integrity.Result:Forty-four patients included in this study,25 male and 19 female,median age 18 years,rang 12-74 years,average (23.68±12.82)years.The follow-up time average more than 10 years,average (121.36±121.36)months,rang 97-162 month.The overall survival rate was 43.19%(19/44),the median survival time was 27 months,and the average survival time was (64.07±52.36)months,rang 6-162 month.25 cases have been dead,the deaths occur in 1,3,5,10 years after diagnosed were 44%(11/25),88%(22/25),96%(24/25) and 100%(25/25) respectively.The general metastatic rate as high as 65.91%(29/44) through the course of disease,metastasis happened in the immediate,1,3,5,10 years after diagnosed were 13.79%(4/29),75.86%(22/29) and 96.55%(28/29),100%(29/29) and 100%(29/29) respectively.The 10 years survival rate of patients with or without metastasis was 31.03%(9/29) and 66.7%(10/15) respectively(P<0.000). Conclusion:The survival rate is obviously decreased but the metastatic rate slightly changes after a average 10 years follow-up compared with the results of short-term follow-up.The occurrence of metastasis and death is mainly concentrated in the first three years of disease,the mortality rate is significantly higher in patients with metastasis than who without.