儿童骨肉瘤与青年骨肉瘤临床特点比较及预后影响因素分析

比较儿童骨肉瘤与青年骨肉瘤临床特点差异,探讨影响预后的相关因素。方法:回顾2003年10月至2010年3月间收治并确诊为骨肉瘤的107例19岁以下儿童及青年患者的病例资料,并对其预后进行随访,随访时间3～82个月,平均26.1个月,根据年龄将其分为儿童骨肉瘤（≤14岁）及青年骨肉瘤（14～19岁）两组,比较两组患者之间临床特点的差异,并以性别、年龄、KPS评分、肿瘤生长部位、肿瘤体积大小、Enneking外科分期、病理性骨折、手术方式、新辅助化疗、术后辅助化疗次数、局部复发及远处转移12项因素为变量指标,应用Kaplan-Meier法计算患者生存率,应用Log-rank检验进行单因素分析,应用Cox回归模型进行多因素分析,研究这些因素与骨肉瘤患者生存率之间的关系。结果:107例骨肉瘤患者中位生存时间为34个月（95%CI:18.5～49.5）,累计1年和2年生存率分别为（85±4）%和（59±5）%,儿童骨肉瘤与青年骨肉瘤在性别、Enneking外科分期、KPS评分、病理性骨折、肿瘤坏死率、病理分型、肿瘤部位、辅助化疗次数及肿瘤体积大小差异无统计学意义,仅儿童骨肉瘤患者更多接受截肢手术治疗（P=0.036 6）。单因素统计分析显示骨肉瘤有效预后因素为Enneking外科分期、KPS评分、术后辅助化疗次数及是否伴有远处转移,多因素统计分析显示KPS评分、术后辅助化疗次数及是否伴有远处转移是影响预后的独立因素。其他因素如年龄、性别、肿瘤生长部位、肿瘤大小、手术方式、新辅助化疗、局部复发及病理性骨折不具有统计学意义。结论:儿童骨肉瘤与青年骨肉瘤临床特点及预后相似,KPS评分、术后辅助化疗次数及是否伴有远处转移是影响儿童及青年骨肉瘤治疗预后的主要因素。      

成人骨肉瘤52例预后因素的COX比例风险模型分析

目的:探讨与成人骨肉瘤预后相关的因素。方法:回顾性分析2002年7月—2010年3月共52例成人骨肉瘤患者(≥40岁)的临床资料,并对预后进行随访,随访时间为4～119个月。以性别、年龄、Karnofsky功能状态评分、肿瘤部位、肿瘤大小、Enneking外科分期、病理性骨折、手术方式、新辅助化疗、术后辅助化疗次数、局部复发和远处转移这12项因素作为相关因素。应用Kaplan-Meier法计算患者生存率,应用log-rank检验进行单因素分析,应用COX比例风险模型进行多因素分析,探讨这些因素与患者生存率之间的关系。结果:52例成人骨肉瘤患者的中位生存时间为37个月(95%可信区间:34.1～39.9个月),1年和2年生存率分别为86.5%和63.5%。单因素分析显示,成人骨肉瘤的预后与年龄(≤50岁与>50岁)、Karnofsky功能状态评分(≥80与≤70)、术后辅助化疗次数(≥6次与<6次)和病理性骨折相关。多因素分析显示,Karnofsky功能状态评分(P=0.015)、术后辅助化疗次数(P=0.004)和病理性骨折(P=0.008)是与预后相关的独立因素。结论:Karnofsky功能状态评分、术后辅助化疗次数和病理性骨折是影响成人骨肉瘤预后的主要因素,积极的外科治疗和规范的辅助化疗能够有效提高成人骨肉瘤患者的生存率。     

骨肉瘤误诊误治30例的临床特征及预后分析

目的:比较误诊误治骨肉瘤患者与正确诊断和治疗骨肉瘤患者的临床特征和预后差异.方法:回顾性分析2007年1月-2010年2月共30例误诊误治骨肉瘤患者与60例正确诊断和治疗骨肉瘤患者的临床资料,并对预后进行随访,随访时间为6～60个月.比较2组患者年龄、性别、肿瘤部位、Enneking外科分期、Karnofsky体能状况(Karnofsky performance status,KPS)评分、病理类型、手术方式、肿瘤最大径、肿瘤坏死率、辅助化疗周期数、局部复发率和肺转移率的差异.应用Kaplan-Meier法计算2年生存率.结果:2组患者的性别、Enneking外科分期、KPS评分、肿瘤部位、病理类型、手术方式、辅助化疗周期数、局部复发时间和肺转移时间的差异无统计学意义(P＞0.05).误诊误治组发病年龄≥30岁的比例(分别为46.7％和11.7％,P＜0.001)、肿瘤最大径≥10 cm的比例(分别为50.0％和23.3％,P=0.011)、肿瘤坏死率＜90.0％的比例(分别为80.0％和60.0％,P=0.016)、局部复发率(分别为33.3％和10.0％,P=0.006)和肺转移率(分别为63.3％和43.3％,P=0.037)均较正确诊断和治疗组高.误诊误治组患者的中位生存时间为25.5个月(95％可信区间为7.1～58.9个月),正确诊断和治疗组患者的中位生存时间为38.0个月(95％可信区间为12.2～55.0个月),差异有统计学意义(P=0.025).正确诊断和治疗组患者的2年生存率(83.3％)明显高于误诊误治组(63.3％)(P=0.036).结论:年龄≥30岁的骨肉瘤患者易被误诊为良性疾病,对骨肉瘤的误诊误治可导致较高的局部复发率和肺转移率,并缩短生存期.     

32例颌面部骨肉瘤临床特点比较及预后影响因素分析

背景与目的：骨肉瘤是较常发生于青少年的间叶组织来源的恶性肿瘤。多发于四肢，较少发生于颌面部。此类骨肉瘤的治疗大多为手术切除，辅以化疗和放疗。因为较为罕见，国内报道较少。故该研究探讨影响颌面部骨肉瘤预后的相关因素。方法：回顾性分析了2010年1月—2017年1月收治的32例颌面部骨肉瘤的临床病理资料并且对预后进行随访，随访时间为7~90个月，平均为75个月，以性别、年龄、肿瘤大小、手术切缘、肿瘤的生长部位、手术方式、手术后进行辅助化疗的次数、局部复发及转移这9项因素作为变量。应用Kaplan-Meier计算并分析其生存率，应用log-rank进行单因素分析检验，应用Cox回归模型进行多因素分析，研究这些因素和患者的生存率之间的关联。结果：32例骨肉瘤患者中位总生存期(overall survival，OS)为(47.6±8.4)个月(95%CI：31.1~64.1)，累计1年和2年生存率分别为84%和72%，5年生存率为44%。单因素分析结果显示，骨肉瘤的手术切缘、术后化疗与患者的复发有关。肿瘤直径、手术切缘、术后辅助化疗是影响骨肉瘤生存的因素。多因素分析结果显示，肿瘤大小、术后辅助化疗是影响颌面部骨肉瘤患者治疗预后的主要因素。其他变量差异无统计学意义。结论：颌面部骨肉瘤有独特的生物学特性和预后，手术切缘和术后辅助化疗次数是影响骨肉瘤患者预后的主要因素。     

伽玛刀治疗40例骨肉瘤肺转移患者的生存分析

目的探讨伽马刀治疗骨肉瘤肺转移患者的生存情况,并分析影响其预后的相关因素。方法回顾性分析上海交通大学附属第六人民医院2008-01-01-2012-12-31共40例骨肉瘤肺转移患者接受伽马刀治疗的临床资料,使用Kaplan-Meier法绘制生存曲线,并采用Log-rank进行单因素检验,并通过Cox回归模型分析与患者生存有关的独立影响因素。结果 40例骨肉瘤肺转移患者2年生存率为42.5%,中位生存时间为27个月,95%CI为19.4~34.6个月。Log-rank单因素分析结果显示,伽玛刀治疗骨肉瘤肺转移患者的预后与性别(P=0.901)、年龄(P=0.903)、KPS评分(P=0.936)、单/双肺转移(P=0.522)、有无肿瘤原发部位的复发(P=0.985)、有无除肺以外的远处转移(P=0.333)、原发部位的手术方式(P=0.359)及有无行新辅助化疗(P=0.415)均无关,而与肺转移瘤数目有关,P=0.032。Cox模型多因素回归分析结果显示,肺转移瘤数目是影响预后的独立相关因素,P=0.039。结论伽玛刀治疗骨肉瘤肺转移患者预后较好,值得做进一步临床研究。肺转移瘤数目对接受伽玛刀治疗的肺转移患者的生存时间有影响。     

肢体骨肉瘤合并病理性骨折39例患者的临床特征及预后相关因素分析

目的:比较合并病理性骨折与未合并病理性骨折肢体骨肉瘤患者的临床特征,并探讨影响预后的相关因素。方法:回顾性分析2003年10月—2011年10月确诊为肢体骨肉瘤的244例患者的病历资料,根据是否合并病理性骨折分为合并病理性骨折与未合并病理性骨折两组,比较这两组患者临床特征的差异。应用Kaplan-Meier法进行生存分析,应用log-rank检验进行病理性骨折组预后的单因素分析,应用COX比例风险回归模型进行预后的多因素分析。结果:与未合并病理性骨折相比,合并病理性骨折的肢体骨肉瘤患者的肿瘤体积较大(P=0.012),上肢骨肉瘤(P=0.004)以及接受截肢手术的患者所占比例较高(P=0.032),且易出现局部复发(P=0.002)。病理性骨折组的中位生存时间为16个月,未合并病理性骨折组的中位生存时间为21个月(P=0.006)。单因素分析显示,肿瘤大小、Enneking外科分期、Karnofsky体能状况评分、术后辅助化疗次数、局部复发和远处转移是影响病理性骨折患者预后的相关因素(P<0.05)。多因素分析显示,Karnofsky体能状况评分、术后辅助化疗次数和远处转移是影响预后的独立相关因素。结论:合并病理性骨折的肢体骨肉瘤患者与未合并病理性骨折的患者相比,肿瘤体积较大,上肢骨肉瘤以及接受截肢手术的比例较高,易出现局部复发,且预后较差。KPS评分、术后辅助化疗次数和远处转移是影响合并病理性骨折的肢体骨肉瘤患者预后的独立因素。     

乳腺癌根治术局部复发后影响预后的相关因素分析

目的研究乳腺癌根治术局部复发后影响预后的相关因素,探讨乳腺癌根治术后局部复发的最佳治疗方案。方法回顾性分析天津肿瘤医院1975年1月至2003年1月期间收治的1067例乳腺癌根治术后复发患者,采用χ2检验或秩和检验对患者年龄、绝经情况、原发瘤临床分期、腋窝淋巴结转移情况、无病间期、复发部位、胸壁复发灶数目及其最大直径、雌激素受体(ER)或孕激素受体(PR)表达、人类表皮生长因子受体2(HER-2)表达等临床病理特征以及不同治疗方案与局部复发治疗的近期疗效和远处转移率之间的关系进行单因素分析;使用Kaplan-Meier法及COX回归模型对乳腺癌根治术复发后影响5年生存率的相关因素进行单因素与多因素分析。结果对全部1067例病例进行随访,778例(72.9%)出现远处转移,复发后5年总生存率为42.4%。复发部位、胸壁复发灶数目及其最大直径、有无放射治疗、放射治疗范围、有无化疗、有无手术切除或切除活检等因素的不同亚组间局部控制率的差异有统计学意义(P0.050);腋窝淋巴结转移情况、无病间期、ER或PR表达、HER-2表达以及再治疗中有无化疗等因素的不同亚组间远处转移率的差异有统计学意义(P0.050);无病间期、复发部位、胸壁复发灶数目、ER或PR表达、HER-2表达、治疗方法等因素的不同亚组间5年总生存率的差异有统计学意义(P0.050);无病间期≤2年、复发部位多、治疗方案单一、局部控制率低及ER、PR均阴性是导致复发性乳腺癌预后差的独立因素(P0.050)。结论多部位复发、胸壁多发结节及胸壁复发灶最大直径3cm者局部控制不佳,局部扩大野放射治疗结合化疗和(或)手术是改善局部控制率的较好模式;有腋窝淋巴结转移、2年内复发、ER、PR均阴性以及HER-2阳性表达的乳腺癌复发后容易发生远处转移,复发再治疗中化疗能减少远处转移的发生;对于复发性乳腺癌采取综合治疗方案可以提高复发患者的生存率;无病间期长,多部位复发,ER或PR阴性者提示预后不良。     

根治术后局部复发性直肠癌的预后因素分析

目的 探讨影响直肠痛根治术后局部复发患者预后因素以及术后联合辅助治疗的疗效.方法 搜集2000年4月至2004年4月间105例局部复发性直肠癌再次治疗患者的病例资料和随访结果,回顾分析17项临床病理因素和患者预后的关系.确定影响局部复发性直肠癌预后的独立因素并对复发后不同治疗方式进行评价.结果 随访率为95.2%,1、3、5年总生存率分别为63%、34%、19%,中位生存时间23个月.手术+放化疗(34例),单纯手术(35例)和放化疗(36例)的1、3、5年生存率分别为79%、55%、32%,68%、40%、14%和64%、36%、11%(χ~2=7.96,P=0.019).单因素分析结果表明原发肿瘤组织学分级、浸润深度、转移淋巴结数、首次术后分期、复发部位、复发时间及复发后治疗方式与预后相关;其中首次术后TNM分期、复发部位、复发时间和复发后治疗方法是影响根治术后局部复发直肠癌患者预后的独立因素.手术联合放化疗的5年生存率明显优于单纯手术及单纯辅助治疗.结论 首次术后TNM分期、复发部位、复发时间和复发后治疗方式是局部复发性直肠癌的独立预后因素,手术联合放化疗可能会给局部复发性直肠癌患者带来长期生存机会.     

骨肉瘤COSS-96方案综合治疗效果分析

目的:评价化疗联合手术治疗骨肉瘤的临床疗效.方法:选择2005-04-2007-12收治初诊骨肉瘤患者19例,引用德国骨肉瘤协作组织COSS-96化疗方案行术前新辅助化疗,完成后行保肢手术17例,截肢2例.依据肿瘤标本组织学坏死率评估新辅助化疗效果,制订术后辅助化疗方案,对具备手术治疗条件的肺转移瘤患者行解救性化疗及转移病灶切除.结果:术后肿瘤细胞坏死率组织学评估Ⅰ级2例,Ⅱ级4例,Ⅲ级9例,Ⅳ级4例.17例保肢患者术后5例出现并发症,经对症治疗后恢复;术后功能评定优7例,良5例,可3例,差2例;优良率为70.6％(12/17).19例患者均获随访,随访18～92个月,平均随访67.3个月,无瘤生存12例(局部复发2例),带瘤生存1例,死亡6例,5年生存率63.2％(12/19).不良反应主要表现为消化道反应、骨髓抑制和肝功能损害等.结论:应用COSS-96方案联合手术治疗骨肉瘤临床疗效满意,积极治疗肺转移瘤可改善患者预后.     

复发性肢体骨肉瘤预后因素分析

目的　探讨影响复发性肢体骨肉瘤预后的相关因素。方法　回顾分析２００２年１月至２００７年１２月收治的１３７例复发性肢体骨肉瘤的临床病理资料以及与预后相关因素。结果　１３７例肢体骨肉瘤复发后的２年生存率为４２.６％。Ｋａｐｌａｎ-Ｍｅｉｅｒ单因素分析显示,复发后病灶切除与否、复发部位、肺转移灶数目以及至复发时间对复发后生存时间有显著影响（Ｐ＜０.０５）,而年龄、性别、病理类型以及复发后化疗与否对复发后生存时间无明显影响（Ｐ＞０.０５）。多因素Ｃｏｘ比例风险回归模型分析显示,复发后病灶切除和至复发时间是影响复发后生存时间的独立预测因素（Ｐ＝０.００８和Ｐ＝０.００１）。结论　至复发时间和复发病灶完全切除对肢体骨肉瘤患者的复发后生存时间有重要影响;复发后化疗的价值需要进一步证实。     

60例局部复发性骨肉瘤患者的预后影响因素分析(英文)

Objective:The aim of this study was to identify prognostic factors and imply the appropriate management for local recurrent osteosarcoma.Methods:The clinical records of 60 patients with local recurrence osteosarcoma were reviewed between January 2002 and December 2010.The mean followed-up time for these patients was 49.1 months(range 13 to 143 months).The factors of age,gender,tumor site,tumor size,surgical procedure,neoadjuvant chemotherapy,frequency of primary postoperative adjuvant chemotherapy,lung metastasis,metastasis of other sites(except for lung) and treatment after local recurrence were selected as the measurements for this analysis.Kaplan-Meier method was used to measure the overall survival and post-recurrence survival.The univariate analysis was used to determine the prognostic factors related with survival by Log-rank test.The COX proportional-hazard regression model was used to analyze the correlation between the prognostic factor and the survival.Results:The median post-recurrence survival and overall survival of 60 patients were 32 months(95% confidence interval:16.2-47.8) and 55 months(95% confidence interval:39.3-70.7) respectively.The 2and 3-year cumulative survival rates were 81.7% and 55.4%,respectively.The Log-rank univariate analysis showed that age,gender,tumor size,metastasis of other sites(except for lung) and treatment after local recurrence were associated with the prognosis of osteosarcoma with local recurrence(P < 0.05).The Cox regression analysis revealed that gender(P = 0.016),metastasis of other sites(except for lung,P = 0.017) and treatment after local recurrence(P = 0.028) were the independent prognostic factors of osteosarcoma with local recurrence.On the other hand,the prognosis of local recurrent osteosarcoma was not associated with tumor site,surgical procedure,frequency of primary postoperative adjuvant chemotherapy,neoadjuvant chemotherapy and lung metastasis(P > 0.05).Conclusion:The independent prognostic factors for local recurrent osteosarcoma were the metastasis of other site(except for lung) and the treatment after local recurrence.The aggressive surgical treatment for local recurrence and distant metastasis could effectively improve the survival of local recurrent osteosarcoma.     

Treatment algorithm for locally recurrent osteosarcoma based on local disease-free interval and the presence of lung metastasis

BACKGROUND: Local recurrence in osteosarcoma is clinically distinct from metastasis, although associated with a similar reduction in survival. The prognostic factors in locally recurrent osteosarcoma were investigated and these factors were translated into a management strategy. METHODS: In all, 407 consecutive patients with skeletal osteosarcoma between 1977 and 2002 were analyzed. Twenty-three patients with resectable local recurrence were analyzed. Clinical and tumor-related factors were assessed for significance in relation to survival and a management strategy was formulated based on factors found to be independently significant for survival. RESULTS: Seventeen of the 23 patients underwent primary resections and initial treatment, yielding an overall local recurrence rate of 4.2% for resectable cancer. Median time to local recurrence was 13 months (95% confidence interval, 9-16 months). The 5-year and 10-year survival rates in the recurrent cases were 29% and 10%, respectively. All patients received chemotherapy both for their primary and recurrent disease. Increased risk of local recurrence (P < .0001) was strongly correlated with positive margins of resection. The rate of local recurrence was not related to chemotherapy-associated necrosis in the primary tumor. Nevertheless, neoadjuvant therapy halved the risk of local recurrence (odds ratio, 1.92; P = .3, power 10%). The strongest correlate with poor survival was local recurrence within the first year after primary resection (P = .001), followed by metastasis at the time of first local recurrence (P = .04) and failure to achieve clinical remission after disease recurrence (P = .04). Chemotherapy-associated necrosis and margins of resection of the primary tumor were not significant prognostic variables for survival. Survival differed significantly among patients defined by local disease-free interval and lung metastasis (P = .0001). They required an individualized approach as captured in the management algorithm. CONCLUSION: There is a residual risk of local recurrence in patients despite favorable chemotherapy-associated necrosis and negative margins of resection. A treatment strategy emphasizing clinical remission at all identifiable sites offers the highest likelihood of survival in this patient population.     

Clinical outcomes of 54 pelvic osteosarcomas registered by Japanese musculoskeletal oncology group

BACKGROUND: To determine the clinical outcomes in patients with pelvic osteosarcoma, we reviewed the experience with 54 pelvic osteosarcoma patients. METHODS: Thirty-five patients underwent surgical treatment with 30 undergoing limb salvage procedures and 5 requiring hemipelvectomies. RESULTS: Oncological outcome was continuously disease free in 12 cases, no evidence of disease in 3, alive with disease in 3, died of disease in 34 and died of other causes in 2. The 5-year survival rate was 29.5%. For the patients who underwent surgery, statistically significant prognostic factors were chemotherapy, surgical margin, tumor location in sacrum, efficacy of chemotherapy, local recurrence, metastasis and treatment for metastases. With univariate analysis, local recurrence, surgical margin and tumors resected from the sacrum were significant prognostic factors for metastasis. Surgical margin, tumor resected from sacrum and metastasis were significant prognostic factors for local recurrence. With regard to postoperative functional mobility, patients with tumors resected from the sacrum exhibited poorer functional mobility when compared with other sites. CONCLUSIONS: Patients with tumors located in the sacrum had worse prognosis, and significant prognostic factor for local recurrence and metastasis. Treatment of pelvic osteosarcoma especially located in the sacrum requires new approaches and further improvements in order to ensure successful outcomes.     

新辅助治疗联合手术治疗后复发食管鳞癌再程治疗的预后分析

目的 分析新辅助治疗联合手术治疗后复发的食管鳞癌再程治疗疗效及影响预后因素。方法 回顾分析2011-2015年间新辅助治疗+手术治疗后失败的152例胸段食管鳞癌治疗失败后总生存(OS)及不同挽救治疗的疗效及预后因素。Kaplan-Meier法计算OS,Cox模型多因素预后分析。结果 术后首次复发的中位间隔时间为10.6(2.0~69.1)个月。复发后的中位OS期为8.0(0.8~43.3)个月。全组患者复发后的1、2、3年OS率分别为36.0%、15.1%、5.2%。单纯局部区域复发、单纯远处转移、局部区域复发合并远处转移患者进展后中位OS期分别为11.3(1.8~43.3)、6.7(1.2~28.6)、5.1(0.8~22.9)个月。多因素分析显示新辅助化疗、ypTNM分期、复发后综合治疗、局部区域复发与复发食管鳞癌OS相关(P=0.009、0.012、0.000、0.026)。结论 新辅助治疗模式、ypTNM分期、复发模式及复发后治疗模式是是影响新辅助治疗+手术治疗后复发食管鳞癌的预后因素。新辅助治疗后复发食管鳞癌总体预后不佳,复发后应根据复发位置、新辅助治疗模式、患者体力状态等因素采用综合治疗模式以使患者取得最大挽救治疗获益。     

新辅助治疗联合手术治疗后复发食管鳞癌再程治疗的预后分析

目的 分析新辅助治疗联合手术治疗后复发的食管鳞癌再程治疗疗效及影响预后因素。方法 回顾分析2011-2015年间新辅助治疗+手术治疗后失败的152例胸段食管鳞癌治疗失败后总生存(OS)及不同挽救治疗的疗效及预后因素。Kaplan-Meier法计算OS,Cox模型多因素预后分析。结果 术后首次复发的中位间隔时间为10.6(2.0~69.1)个月。复发后的中位OS期为8.0(0.8~43.3)个月。全组患者复发后的1、2、3年OS率分别为36.0%、15.1%、5.2%。单纯局部区域复发、单纯远处转移、局部区域复发合并远处转移患者进展后中位OS期分别为11.3(1.8~43.3)、6.7(1.2~28.6)、5.1(0.8~22.9)个月。多因素分析显示新辅助化疗、ypTNM分期、复发后综合治疗、局部区域复发与复发食管鳞癌OS相关(P=0.009、0.012、0.000、0.026)。结论 新辅助治疗模式、ypTNM分期、复发模式及复发后治疗模式是是影响新辅助治疗+手术治疗后复发食管鳞癌的预后因素。新辅助治疗后复发食管鳞癌总体预后不佳,复发后应根据复发位置、新辅助治疗模式、患者体力状态等因素采用综合治疗模式以使患者取得最大挽救治疗获益。     

Prognostic factors for osteosarcoma of the extremity treated with neoadjuvant chemotherapy: 15-year experience in 789 patients treated at a single institution

BACKGROUND: The evaluation variables influencing systemic and local recurrence and final outcome are extremely important in defining risk-adapted treatments for patients with nonmetastatic osteosarcoma of the extremity. METHODS: A homogeneous group of 789 patients treated at a single institution between March 1983 and March 1999 with different protocols of neoadjuvant chemotherapy, with a minimum followup of 5 years, were retrospectively evaluated in relation to gender, age, serum levels of alkaline phosphatase, tumor site and size of the pathologic fracture, type of surgery, protocol of chemotherapy, surgical margins, and histologic response to preoperative treatment. RESULTS: The 5-year event-free survival (EFS) and overall survival rates were 60.1% and 67.5%, respectively. Upon univariate analysis, EFS was significantly related to the age of patients, serum value of alkaline phosphatase, tumor volume, histologic subtype, type of surgery, surgical margins, histologic response to preoperative treatment, and chemotherapy protocol. Local recurrences (4.8%) were significantly correlated with surgical margins. The 5-year post-recurrence EFS survival was 17% and was significantly lower for patients who had a local recurrence and metastases than for those with metastases only. Patients who had a recurrence only in the lung had a post-recurrence survival rate significantly better than others, correlated with the number of metastatic nodules and the length of the disease-free interval. CONCLUSIONS: Upon multivariate analysis, age < or = 14 years, high serum levels of alkaline phosphatase, tumor volume > 200 mL, a two-drug regimen chemotherapy, inadequate surgical margins, and poor histologic response to treatment maintained independent prognostic values on the outcome of nonmetastatic osteosarcoma of the extremities. These factors must be considered when deciding risk-adapted treatments for osteosarcoma patients.     

p21活化激酶5在骨肉瘤组织中的表达及临床意义

背景与目的：p21活化激酶5(p21-activated kinase 5,PAK5)为PAKs家族中新近发现的成员,在细胞骨架重组,细胞生长、增殖、分化,基因转录及细胞凋亡等一系列的细胞功能中发挥重要作用。近来有研究发现PAK5参与了胃癌、肠癌等恶性肿瘤的发生发展过程。本研究旨在探讨PAK5在人骨肉瘤组织中的表达及其与骨肉瘤患者预后的关系。方法：应用免疫组化方法检测92例骨肉瘤活检样本石蜡组织中PAK5蛋白的表达,33例骨巨细胞瘤样本作为阴性对照,并分析PAK5表达与骨肉瘤患者临床参数及生存之间的关系。结果：骨肉瘤组织中PAK5蛋白表达阳性率为71.7%(66/92),骨巨细胞瘤中未见PAK5表达(0/33)。PAK5表达与患者的性别、年龄、肿瘤部位、肿瘤大小、组织学类型、局部复发等无关,而与Enneking分期、肿瘤坏死率和肺转移相关,且PAK5高表达能降低化疗的有效率。单因素分析表明,肿瘤大小、Enneking分期、局部复发、肺转移及PAK5表达水平是影响骨肉瘤患者预后的因素。多因素分析显示,PAK5表达水平(P=0.001)及肺转移(P=0.015)是影响骨肉瘤预后相关的独立的重要因素。结论：PAK5表达水平与Enneking分期、肿瘤坏死率和肺转移相关;PAK5的表达可作为骨肉瘤预后预测的指标;PAK5高表达能降低化疗的有效率。     

CD133和CD44在骨肉瘤中的表达及其临床意义

 目的
探讨CD133和CD44在骨肉瘤中的表达情况及其与骨肉瘤患者预后的关系。方法应用免疫组织化学方法检测CD133和CD44在79例骨肉瘤
患者石蜡切片标本中的表达情况,应用卡方检验比较CD133、CD44表达与患者临床病理资料的相互关系,Kaplan-Meier法计算患者生存
率,Log rank检验比较CD133、CD44阴性低表达组与高表达组患者之间的生存差异,并以性别、年龄、肿瘤部位、肿瘤大小、
Ennecking 分期、CD133和CD44表达水平、局部复发及肺转移为变量指标,应用Cox回归模型进行多因素分析,研究这些因素与骨肉瘤
患者生存率之间的关系。结果CD133和CD44的表达水平与患者性别、年龄、肿瘤部位、肿瘤大小、Ennecking分期及局部复发无关,发
生肺转移的骨肉瘤患者其CD133和CD44的表达明显高于未发生转移的骨肉瘤患者,差异有统计学意义(P值分别为0.00014和0.0008)。
经单因素生存分析表明,影响骨肉瘤患者预后的因素有：肿瘤大小,局部复发,肺转移,CD44和CD133表达水平。多因素分析显示CD133
和CD44表达水平及肿瘤大小是影响患者预后的独立影响因素。结论CD133和CD44表达水平与骨肉瘤肺转移密切相关,检测CD133和CD44
的表达可以作为骨肉瘤患者肺转移及预后预测的指标。     

Retrospective analysis of clinical characteristics and prognostic factors for pathologic fracture in 44 patients with extremity osteosarcoma简

Objective： The aim of this study was to identify the clinical features and prognostic factors associated with ex- tremity osteosarcoma with pathologic fracture. Methods： The clinical records of 271 patients with extremity osteosarcomas were retrospectively reviewed. The data obtained covered the period from October 2003 to May 2012, and included sex, age, tumor site etc. The mean follow-up time was 25.2 months （ranged from 1 to 117）. Chi-square method and Kaplan-Meier method were used to compare clinical differences and overall survival between patients with or without pathologic fracture, respectively. The univariate analysis was used to determine the prognostic factors related with survival rate by log-rank test. The multivariate analysis of prognosis was performed by COX proportional hazards regression model. Results： The proportions of patients having a tumor＇s diameter of 10 cm or more （P = 0.038）, locating upper limbs （P = 0.004） and receiving amputation surgery （P = 0.02） were significantly higher with pathological fracture group than without pathological fracture group. The local recurrence rate （P = 0.000） was also significantly higher in the pathological fracture group. The median survival time of patients with or without pathological fracture was 16 （95% confidence interval： 14.6-17.4） months and 22 （95% confidence interval： 19.8-24.1） months （P = 0.002）. The Log-rank univariate analysis indicated that the tumor size, Enneking＇s surgical staging, Karnofsky performance status （KPS） score, cycles of adjuvant chemotherapy, local recurrence and metastasis were significantly related to overall survival. Multivariate Cox regression analysis revealed KPS score, cycles of adjuvant chemotherapy and metastasis were independent prognostic factors （P 〈 0.05）. Conclusion： Compared with the patients without pathological fracture, a higher proportion of patients receiving amputation surgery or having larger tumor size, humeral osteosarcoma or local recurrence was observed in patients with pathological fracture, and the prognosis of these patients was poor. The independent prognostic factors of extremity osteosarcoma with pathologic fracture were the KPS score, cycles of adjuvant chemotherapy and metastasis.     

骨肉瘤患者预后的影响因素分析

目的:通过对真实世界骨肉瘤患者数据进行回顾性分析,充分及深入了解影响骨肉瘤患者预后的影响因素。方法:收集空军军医大学（原第四军医大学）第一附属医院自2014年01月至2017年05月期间住院的82例骨肉瘤患者,其中包括男性患者48例,女性患者34例,年龄9~54岁,中位年龄17岁。对性别、年龄、肿瘤原发部位、临床分期、病理学分型、肺转移数目、肺转移治疗等方面进行预后分析。结果:临床分期、肺转移数目、肺转移治疗方式对患者生存率有显著影响;肿瘤临床分期、肺转移治疗方式是影响生存的独立预后因素。结论:肺转移可明确影响骨肉瘤患者预后,对于肺转移的早期发现、及时治疗可以明显提高骨肉瘤患者的预后,此外,对于肺转移的多学科综合治疗可以提高骨肉瘤患者的生存。