异时性多中心骨肉瘤治疗的中长期随访结果

Mid-long term results of treatment in patients with metachronous multicentric osteosarcoma

目的探讨异时性多中心骨肉瘤(MMOS)的中长期治疗结果。方法回顾分析2001年1月至2018年6月北京积水潭医院骨肿瘤科收治的40例MMOS患者的临床资料。记录所有病例的流行病学资料、初诊时间、发病部位、化疗和手术方案、碱性磷酸酶(AKP)和乳酸脱氢酶(LDH)水平、新发骨肉瘤病灶的进展时间和部位、肿瘤学随访结果等指标。对其中34例完成6个月以上随访患者进行生存和预后分析。采用SPSS 21.0软件对数据进行处理。分别采用χ^2检验或精确概率法、配对t检验、Kaplan-Meier法、Log-rank法与Cox回归比例风险模型对数据进行分析。结果40例患者中男26例、女14例,年龄和中位年龄分别为(20.3±11.9)(10~61)岁和16.5(13,20)岁。进展为多中心骨肉瘤(MOS)病灶的时间和中位时间分别为(29.9±23.5)(7~107)个月和21.5(15,36)个月。34例患者完成6个月以上随访,随访时间和中位随访时间分别为(56.9±39.4)(17~198)个月和46(31.5,69.0)个月。至随访期末20例患者病死。总体5年和10年生存率分别为48.5%和32.8%。5年生存率新发病灶手术与否患者分别为55.1%和35.1%,安全切缘与否患者分别为31.3%和0,病灶进展时间超过24个月与否患者分别为68.8%和22.1%,差异均有统计学意义(P=0.039,0.030,0.002)。患者1,2,3,5年肿瘤无进展生存率分别为88.2%,35.3%,26.5%和8.8%。单因素分析结果显示异时病灶是否经手术治疗和病灶进展时间对患者生存率有显著影响。多因素分析结果显示异时病灶进展时间是影响预后的独立危险因素。结论MMOS治疗后中长期患者生存率低,异时病灶进展时间是影响MMOS患者预后的独立因素。

Objective To evaluate the mid-long term results of treatment in patients with metachronous multifocal osteosarcoma(MMOS).Methods Data of 40 patients with MMOS admitted to Department of Orthopaedic Oncology Surgery,Beijing Jishuitan Hospital from January 2001 to June 2018 were retrospectively analyzed.The epidemiological data,the first visit and time nodes of heterochrony lesion,the esion location,chemotherapy,surgical treatment,level of alkline phosphatase(AKP)and lactate dehydrogenase(LDH),the progression time and location of newly developed lesions and oncological result were collected for statistical analysis(SPSS 21.0).Survival and prognosis were analyzed in 34 cases with complete follow-up data.Results There were 26 males and 14 females aged(20.3±11.9)(10-61)years and median age was 16.5(13,36)years.The interval of lesion progression and it's median were(29.9±23.5)(7-107)and 21.5(15,36)months,respectively.The follow-up duration of 34 patients with complete follow-up and it's median were(56.9±39.4)(17-198)and 46(31.5,69.0)months,respectively.Twenty patients died by the end of follow-up.The 5-and 10-year overall survival rates were 48.5%and 32.8%,respectively.The 5-year survival rates were 55.1%and 35.1%for patients with and without surgery for the second lesion(P=0.039),30.5%and 0 for patients with and without safe margin(P=0.030),22.1%and 68.8%for patients with time to second lesion progression<24 months and≥24 months,respectively(P=0.002).The 1-,2-,3-and 5-year progression-free survival rates were 88.2%,35.3%,26.5%and 8.8%,respectively.Univariate analysis results showed significant difference in survival rate relevant to surgery of progressive lesions and interval of new lesion progression while multivariate analysis results showed time interval of lesions progression was an independent risk factor affecting prognosis.Conclusion The mid-long term survival rate of patients with MMOS is low,the time to second lesions progression is an independent prognostic factor affecting the survival rate of patients with MMOS.