中老年骨肉瘤患者化疗选择及预后的单中心五年回顾性研究

Chemotherapy selection and prognosis analysis of osteosarcoma in the elderly:a single-center 5-year retrospective study

目的探讨老年骨肉瘤患者的临床特点、化疗选择、毒副作用及其预后危险因素。方法回顾分析2010年6月至2015年6月,我中心收治的骨肉瘤178例中,年龄≥50岁的28例。化疗方案为ADM/THP/L-ADM+DDP,IFO,新辅助2~4周期,术后6~8周期。运用SPSS 18.0软件进行统计学分析,预后因素采用χ^(2)检验;根据相关随访资料统计生存率。结果本组28例,男13例,女15例,平均年龄(59.9±5.8)岁。28例获平均39个月的随访。随访率为100%。28例中26例接受手术治疗,10例行术前新辅助化疗,15例行辅助化疗。本组28例5年总体生存率为34.8%,术前新辅助化疗患者5年总体生存率为20%,未行术前新辅助化疗患者5年总体生存率为30.3%,是否行新辅助化疗对于老年骨肉瘤患者的生存差异无统计学意义,化疗患者5年生存率(17.5%)低于不化疗患者(54.8%)(P<0.05)。其中2例患者因化疗引起的骨髓抑制、感染后死亡。局部肿瘤复发是肿瘤预后差的独立因素,复发患者生存率(7.8%)与无复发患者生存率(55.6%)差异有统计学意义(P<0.05)。结论年龄>50岁的老年骨肉瘤患者化疗受益较少,且化疗副反应明显,须慎重选择。

Objective To investigate the clinical characteristics,chemotherapy options,side effects and prognostic risk factors of osteosarcoma in elderly patients.Methods All 178 cases of osteosarcoma were treated in our center from June,2010 to June,2015.Twenty-eight elderly patients (≥ 50 years old) with osteosarcoma were retrospectively analyzed.Chemotherapy regimens:ADM / THP / ADM + DDP;IFO;2-4 cycles of neoadjuvant and 6-8 cycles postoperatively.SPSS 18.0 software was used for statistical analysis.Prognostic factors were analyzed by chi square test.Results A total of 28 patients were selected,including 13 males and 15 females with an average age of (59.9±5.8) years.All were followed up for an average of 39 months (follow-up rate 100%).Twenty-six patients underwent surgery,including 10 patients with preoperative neoadjuvant chemotherapy and 15 patients with adjuvant chemotherapy.The 5-year overall survival rate of 28 patients who were followed up was 34.8%.The 5-year overall survival rate of patients with preoperative neoadjuvant chemotherapy was 20%,and that of patients without chemotherapy was 30.3%.The 5-year overall survival rate of chemotherapy patients was lower than that of patients without chemotherapy.Two patients died of bone marrow suppression and infection caused by chemotherapy.Local tumor recurrence (recurrence,7.8%;no recurrence,55.6%) was an independent factor of poor prognosis (P < 0.05).Conclusions The elderly osteosarcoma patients over 50 years benefit less from chemotherapy with obvious side effects.Careful selection should be made before application.