四肢骨肉瘤患者误诊误治的预后分析

The prognosis of patients with extremity osteosarcoma who have undergone misdiagnosis and mistreatment

目的探讨四肢骨肉瘤误诊及误治的预后情况。方法回顾性分析2009年1月至2021年12月东部战区总医院收治的高级别骨肉瘤322例患者的病历资料,299例患者术前接受规范的新辅助化疗和手术(规范化治疗组),23例患者首诊被误诊为良性病变或炎症接受手术(误诊误治组)。统计分析两组患者性别、年龄、首次手术方式、复发间隔时间、转移间隔时间、总存活时间、生存情况以及误诊误治组肿瘤部位、再次手术方式。两组间临床特征比较采用χ2检验,采用Kaplan-Meier生存分析及Log-rank检验分析两组患者的生存率。结果322例患者全部获得随访,规范化治疗组男184例、女115例,年龄为24岁(9,29)岁,随访时间为42个月(9,65)个月。保肢手术255例,保肢率为85.3%(255/299);截肢手术44例,截肢率为17.7%(44/299)。复发25例,复发率为8.4%(25/299),复发间隔时间为(22.8±8.3)个月(范围7~36个月)。转移84例,转移率为28.1%(85/299),转移间隔时间为34.5个月(27,41)个月。误诊误治组男17例、女6例,年龄(34.1±18.7)岁(范围5~67岁),随访时间为(53.7±39.8)个月(范围9~138个月)。11例患者二期给予保肢治疗,保肢率为47.8%(11/23);7例接受截肢治疗,截肢率为30.4%(7/23);5例患者未行手术治疗。复发6例,复发率为26.1%(6/23),复发间隔时间为5个月(1.5,26.5)个月。肺部转移10例,转移率为43.4%(10/23),转移间隔时间为18.5个月(5,40)个月。误诊误治组五年生存率为50.7%,规范化治疗组五年生存率为56.1%,组间差异无统计学意义(χ^(2)=0.09,P=0.760)。结论高级别骨肉瘤患者误诊误治后给予标准化疗,以及再次保肢或截肢手术,其五年生存率与规范化治疗的患者相当,但截肢率更高,再次术后复发率及转移率增加,复发时间更早。

Objective To compare outcomes between standardized and misdiagnosis and mistreatment of osteosarcoma.Methods A retrospective analysis of patients with high-grade osteosarcoma who received appropriate surgical treatment and chemotherapy(299 cases,control group)and those who were misdiagnosed(benign or infective)and received mistreatment(23 cases,study group)between January 2009 and December 2021.Gender,age,first operation mode,recurrence time,recurrence interval,metastasis time,metastasis interval,total survival time(months),survival status in the two group and tumor site reoperation mode in the study group were statistically analyzed.Further,chi-square test was performed for comparison of the clinical between two groups.The survival analysis was performed using Kaplan-Meier test and Log-rank test.Results All the 322 patients were followed up.In the control group,the average follow-up time was 42 months(1-137 months),the average age was 24 years(3-80 years),male 184 cases,female 115 cases,and limb salvage rate was 85.3%(255/299).Seven patients underwent amputation,and the amputation rate was 17.7%(44/299).The recurrence rate was 8.4%(25/299),the average recurrence interval was 22.8 months(7-36 months),and the metastasis rate was 28.1%(85/299),the average metastasis time was 32.7 months(0-58 months).In the study group,the average of follow-up time was 30 months(9-117 months),the average age was 36 years(5-67 years),17 males and 6 females.Among them,eleven patients were treated with limb salvage in the second stage,and the limb salvage rate was 47.8%(11/23).Seven patients underwent amputation,and the amputation rate was 30.4%(7/23).The recurrence rate was 26.1%(6/23),the average recurrence interval was 11 months(1-42 months),and the metastasis rate was 43.4%(10/23),the average metastasis time was 20.3 months(1-44 months).The 5-year survival rate was 50.7%in the study group and 56.1%in the control group.There was no significant difference between the two groups(χ^(2)=0.09,P=0.760).Conclusion The overall prognosis of patients with high-grade osteosarcoma who receive active treatment after mistreatment is similar to that of patients with standardized treatment,but the recurrence and metastasis rate is higher,the recurrence time is earlier,and the amputation rate is higher.