四肢骨肉瘤44例预后分析

Prognosis analysis of 44 patients with extremity osteosarcoma

目的探讨单中心治疗骨肉瘤患者的生存情况。方法回顾性分析2013年1月至2018年1月就诊于山西医科大学第二医院并接受治疗的44例骨肉瘤患者。患者确诊骨肉瘤后给予顺铂联合多柔比星新辅助化疗。查阅并记录患者的基本资料、辅助检查结果、手术方法、病理结果、预后等信息,采用Kaplan-Meier法和Cox回归模型分析各因素与预后的关系。结果44例骨肉瘤患者中,男性23例,女性21例;年龄7~62岁,平均年龄27.2岁;肿瘤部位:上肢5例,下肢39例;肿瘤直径<10 cm 30例,≥10 cm 14例。全部患者均获得广泛或根治性手术,其中保肢手术35例,截肢手术9例。截至随访结束,患者3年总生存率为65.5%;术后局部复发组和无局部复发组的3年总生存率分别为40.0%和72.4%(P=0.037);治疗中或治疗后出现肺转移组与无肺转移组的3年总生存率分别为32.0%和84.5%(P<0.01);肿瘤直径≥10 cm组和<10 cm组的3年总生存率分别为40.2%和78.1%(P=0.003);非规范化疗组与规范化疗组的3年总生存率分别为35.8%和74.9%(P=0.048);诊断时乳酸脱氢酶升高组和正常组的3年总生存率分别为38.1%和72.3%(P=0.010)。多因素分析显示,是否规范化疗(P=0.005)和是否出现肺转移(P=0.003)是影响骨肉瘤患者生存的独立预后因素。结论新辅助化疗结合手术治疗骨肉瘤患者生存率较高,不规范的化疗和治疗中或治疗后出现肺转移影响骨肉瘤患者的生存。

Objective To investigate the survival of patients with osteosarcoma treated in a single institute.Methods A total of 44 patients with osteosarcoma who had undergone surgical treatment in the Second Hospital of Shanxi Medical University from January 2013 to January 2018 were enrolled in this retrospective study.After the diagnosis of osteosarcoma,patients received cisplatin plus doxorubicin neoadjuvant chemotherapy.The patient's basic data,auxiliary examination results,surgical methods,pathological reports,prognosis and other information were reviewed and recorded,and the Kaplan-Meier method,Cox regression model were used to analyze the relationship between various factors and prognosis of patients.Results Among 44 patients,there were 23 males and 21 females,aged from 7 to 62 years old(average 27.2 years old);the tumor site of 5 cases was located at the upper limbs and 39 was located at the lower limbs;the diameter of the tumor was<10 cm in 30 cases,≥10 cm in 14 cases.All patients underwent extensive resection,including 35 cases of limb salvage surgery and 9 cases of amputation.At the end of follow-up,the 3-year overall survival rate was 65.5%.The 3-year overall survival rates in patients with or without local recurrence were 40.0%and 72.4%,respectively(P=0.037).The 3-year overall survival rates in patients with or without lung metastasis were 32.0%and 84.5%,respectively(P<0.01).The 3-year overall survival rates in patients with tumor's diameter≥10 cm or<10 cm were 40.2%and 78.1%,respectively(P=0.003).The 3-year overall survival rates in patients with or without standard chemotherapy were 74.9%and 35.8%,respectively(P=0.048).The 3-year overall survival rates in patients with high or normal lactate dehydrogenase at the time of diagnosis were 38.1%and 72.3%,respectively(P=0.010).Multivariate analysis showed that standard chemotherapy(P=0.005)and lung metastasis(P=0.003)were independent prognostic factors affecting the survival of patients with osteosarcoma.Conclusions Neoadjuvant chemotherapy combined with surgical methods can improve the survival rate of patients with osteosarcoma of the extremities.Nonstandard chemotherapy and lung metastasis during or after treatment affect the survival of patients with osteosarcoma.