股骨远端皮质旁骨肉瘤患者手术治疗的肿瘤学预后及影响因素

Oncological results and influence factors of the surgical treatment of parosteal osteosarcoma in distal femur

目的探索股骨远端皮质旁骨肉瘤的肿瘤学预后及影响因素。方法回顾分析我院骨肿瘤科2009年1月至2021年10月手术的73例股骨远端骨旁骨肉瘤患者,其中男21例,女52例,年龄10~59岁,中位年龄29岁。其中普通皮质旁骨肉瘤55例,去分化皮质旁骨肉瘤18例。将性别,年龄,髓腔是否受侵,外院手术史,病理亚型,外科边界,是否化疗和转移作为影响因素,分析其对肿瘤学预后的影响。结果随访结束时5例死亡,68例存活,死亡患者随访时间为12~56个月,中位随访23个月,存活患者随访时间为24~128个月,中位随访58个月,总体5年生存率为91.6%。局部复发7例,总体复发率为9.6%(7/73)。远处转移10例,总体转移率为13.7%(10/73)。病理亚型对远处转移有明显影响,病理亚型和转移影响患者的生存率。结论股骨远端皮质旁骨肉瘤患者手术为其主要治疗手段,普通皮质旁骨肉瘤预后较好,去分化皮质旁骨肉瘤预后变差,肿瘤级别及转移是影响皮质旁骨肉瘤患者术后生存率的因素。

Objective To detect the oncological results and influence factors of parosteal osteosarcoma in distal femur after surgery.Methods Between Jan 2009 and Oct 2021,73 patients with parosteal osteosarcoma in distal femur were included retrospectively.The cohort comprised 21 males and 52 females with a median age of 29 years(range:10-59 years).Fifty-five cases were conventional parosteal osteosarcomas and 18 cases were dedifferentiated parosteal osteosarcomas.We analyzed sex,age,marrow invasion,surgical history in other hospitals,pathological subtype,surgical margin,chemotherapy and metastasis to find the influence factors of oncological results.Results At the end of follow-up,5 patients died and 68 patients were alive.The follow-up of patients died was 12-56 months(median,23 months),and the follow-up of patients survived was 24-128 months(median,58 months).The overall 5-year survival rate was 91.6%.Local recurrence occurred in 7 cases,and the overall recurrence rate was 9.6%(7/73).There were 10 cases of distant metastasis,and the overall metastasis rate was 13.7%(10/73).Pathological subtype had significant influence on distant metastasis.The pathological subtype and metastasis significantly affected the survival rate of patients.Conclusions The main treatment method of distal femoral parosteal osteosarcoma is surgery.The prognosis of conventional parosteal osteosarcoma is better,while that of dedifferentiated parosteal osteosarcoma is worse.Tumor grade and metastasis are the main factors affecting the survival rate of parosteal osteosarcoma.