骨干骨肉瘤临床特征与预后分析

Analysis on clinical characteristics and prognosis of diaphyseal osteosarcoma

目的分析骨干骨肉瘤的临床特征,对比骨干骨肉瘤患者和干骺端骨肉瘤患者的生存率,归纳骨干骨肉瘤的预后因素。方法收集 2001 年 1 月 1 日至 2016 年 12 月 31 日,在我院经治的 23 例骨干骨肉瘤患者的资料,并与同期诊疗的 94 例干骺端骨肉瘤患者资料进行统计学检验,然后再通过 Kaplan-Meier 分析法计算两组骨肉瘤患者的总生存率、无复发生存率和无转移生存率,并以 Log-rank 检验进行对比,最后用 COX 风险比例回归模型分析影响骨干骨肉瘤患者生存状态的预后因素。结果骨干骨肉瘤患者与干骺端骨肉瘤患者相比,截肢率差异有统计学意义 (χ~2=5.064,P=0.024),且病理性骨折的发生率差异有统计学意义(χ~2=5.382,P=0.020);骨干骨肉瘤患者的 5 年、3 年总生存率均不及干骺端骨肉瘤患者,差异有统计学意义 (χ~2=4.309,P=0.038),无复发生存率差异有统计学意义 (χ~2=19.746,P<0.0001);纳入 COX 回归方程的变量有性别 (χ~2=5.998,P=0.014)、病理类型 (χ~2=4.442,P=0.034;χ~2=5.712,P=0.017) 和截肢 (χ~2=7.605,P=0.006)。结论骨干骨肉瘤患者于干骺端骨肉瘤患者在临床特点上有所不同,且预后差于干骺端骨肉瘤,而预后因素需要扩大样本数量来分析。

Objective To analyze the clinical characteristics of diaphyseal osteosarcoma,compare the survival rate between diaphyseal osteosarcoma and metaphyseal osteosarcoma,and to summarize the prognostic factors of diaphyseal osteosarcoma.Methods Clinical data of 23 patients with diaphyseal osteosarcoma and 94 patients with metaphyseal osteosarcoma were collected from January 1,2001 to December 31,2016 for statistical analysis.The overall survival rate,recurrence-free survival rate,and metastasis-free survival rate of the two groups were calculated and compared by Kaplan-Meier method and Log-rank test,respectively.Finally,the COX hazard ratio regression model was used to analyze the prognostic factors affecting the survival of patients with diaphyseal osteosarcoma.Results Significant differences were observed in amputation rate and pathological fracture incidence between the two groups(χ~2=5.064,P=0.024;χ~2=5.382,P=0.020).5-year and 3-year overall survival rates of patients with diaphyseal osteosarcoma were lower than that of metaphyseal osteosarcoma(χ~2=4.309,P=0.038),as well as the recurrence-free survival rate(χ~2=19.746,P<0.0001).Prognostic factors included gender(χ~2=5.998,P=0.014),pathological types(χ~2=4.442,P=0.034;χ~2=5.712,P=0.017),and amputation(χ~2=7.605,P=0.006).Conclusions Patients with diaphyseal osteosarcoma demonstrate different clinical characteristics from metaphyseal osteosarcoma with worse prognosis.Large-sample analysis is required for further research.