ＲＥＣＫ、ＭＭＰ-２在骨肉瘤中的表达及其临床意义

目的　探讨ＲＥＣＫ、ＭＭＰ-２与骨肉瘤的侵袭转移以及预后的关系。方法　利用免疫组化技术检测２００１年至２００４年我院４９例骨肉瘤患者组织标本中ＲＥＣＫ、ＭＭＰ-２的表达情况,同时结合患者的相关临床病理特点,进而分析其表达的临床意义。结果　４９例骨肉瘤患者组织中ＲＥＣＫ与ＭＭＰ-２表达相关（ｒ＝－０.６０３,Ｐ＜０.０５）。单因素分析提示年龄、性别、肿瘤部位、组织亚型与ＲＥＣＫ、ＭＭＰ-２表达无明显相关性（Ｐ＞０.０５）,而与肿瘤转移及复发状况相关（Ｐ＜０.０５）。４９例骨肉瘤患者５年生存期与ＲＥＣＫ、ＭＭＰ-２表达相关（Ｐ＝０.００３,０.０２８）。结论　ＲＥＣＫ、MＭＰ-２与骨肉瘤转移、复发及预后有关,可作为预测骨肉瘤复发、转移及预后的重要参考指标。     

原发性腹膜后肿瘤术后复发的原因分析

目的：分析原发性腹膜后肿瘤（ＰＲＴ）术后复发的影响因素以减少复发,提高手术效果。方法：回顾分析１９９０年６月～２００７年６月间收治的１３１例原发性腹膜后肿瘤手术患者,通过随访了解术后复发情况并进一步分析其与临床特征和病理类型之间的关系。结果：获随访的１２５例ＰＲＴ患者术后１、３、５年复发率分别为２０.００％（２５／１２５）、３２.６５％（３２／９８）、４３.８４％（３２／７３）;单因素分析显示手术方式（χ^２ ＝６０.０４６,Ｐ＝０.０００）、肿瘤体积（χ^２ ＝５３.３６２,Ｐ＝０.０００）、病理类型（χ^２ ＝１６.９６５,Ｐ＝０.０００）对ＰＲＴ术后复发均有影响（Ｐ＜０.０５）。多因素Ｃｏｘ回归分析表明手术方式（χ^２ ＝３５.０８０,Ｐ＝０.０００）、病理类型（χ^２ ＝１１.３７３,Ｐ＝０.００１）、肿瘤体积（χ^２＝６.８１５,Ｐ＝０.００９）显著影响术后复发。结论：手术方式、肿瘤体积、病理类型与ＰＲＴ患者的术后复发相关,其中手术方式是预测ＰＲＴ患者术后复发最显著的因素。     

ＣＩＫ细胞治疗胃癌患者的相关临床因素对其预后的影响

目的　分析使用细胞因子诱导的杀伤细胞（ＣＩＫ细胞）过继免疫治疗胃癌患者相关临床因素对生存预后的影响。方法　入组７５例接受ＣＩＫ细胞治疗的胃癌患者,用淋巴细胞分离液分离出单个核细胞,将诱导培养后的ＣＩＫ细胞回输给胃癌患者,采用回顾性队列研究,用Ｋａｐｌａｎ-Ｍｅｉｅｒ估计中位生存时间,用Ｌｏｇ-ｒａｎｋ检验比较临床因素对生存的影响。结果 ＣＩＫ治疗组的复发率明显低于化疗组（５３.３％ ｖs．７１.６％）,差异有统计学意义（χ^２＝５.５６６,Ｐ＝０.０１８）。ＣＩＫ治疗组７５例胃癌患者的中位生存时间明显高于化疗组（４９个月ｖｓ．２７个月）,差异有统计学意义（χ^２ ＝１０.９０７,Ｐ＝０.００１）。在ＣＩＫ治疗组中,肿瘤大小、是否复发、病理分级和肿瘤分期显著影响ＣＩＫ的生存预后,差异有统计学意义。结论　ＣＩＫ细胞回输治疗可以明显延长胃癌患者的生存期,但其疗效和预后受到相关临床因素的影响。     

肝细胞癌中Ｓｕｒｖｉｖｉｎ、ＥＧＦＲ和ＶＥＧＦ的表达及临床意义

目的　研究Ｓｕｒｖｉｖｉｎ、ＥＧＦＲ和ＶＥＧＦ在肝细胞癌中的表达情况,为肝癌预后判断和靶向治疗提供理论依据。方法　应用免疫组织化学ＰＶ６０００法检测８１例人肝细胞癌组织、癌旁组织Ｓｕｒｖｉｖｉｎ、ＥＧＦＲ和ＶＥＧＦ的表达并分析其与相关临床病理特征的关系。结果　肝细胞癌组织与癌旁组织Ｓｕｒｖｉｖｉｎ的阳性率无显著差别;肝细胞癌组织ＥＧＦＲ、ＶＥＧＦ的阳性率分别为４９.４％、６３.０％,显著高于癌旁组织的阳性率２１.０％、４４.４％（Ｐ＜０.０５）。Ｓｕｒｖｉｖｉｎ的表达与肿瘤的ＴＮＭ分期和肿瘤直径有关（Ｐ＜０.０５）;ＥＧＦＲ的表达与病理分化和术后复发转移有关（Ｐ＜０.０５）;ＶＥＧＦ的表达与ＴＮＭ分期、术前局部转移及术后复发转移有关（Ｐ＜０.０５）。ＥＧＦＲ与ＶＥＧＦ表达呈正相关（ｒ＝０.３０７,Ｐ＝０.００７）。ＴＮＭ分期、Ｓｕｒｖｉｖｉｎ、ＥＧＦＲ是肝细胞癌的独立预后因子（Ｐ＜０.０５）。结论　肝细胞癌组织Ｓｕｒｖｉｖｉｎ、ＥＧＦＲ和ＶＥＧＦ表达水平较高,其中Ｓｕｒｖｉｖｉｎ、ＥＧＦＲ可以作为肝细胞癌的预后因子。ＥＧＦＲ与ＶＥＧＦ表达正相关,对研发多靶点药物或联合使用多种靶向药物有一定指导意义。     

蜂胶对大鼠急性放射性肠损伤作用的实验研究

目的　研究蜂胶对大鼠照射引起的肠黏膜损伤的作用。方法　３６只ＳＤ雄性大鼠随机分为正常组（ｎ＝１２）、照射组（ｎ＝１２）和蜂胶组（ｎ＝１２）,除正常组外,其余两组于给药后第７天用６ＭＶ高能Ｘ线全腹照射９Ｇｙ,照射后第３天处死大鼠。观察小肠黏膜病理形态变化,测定组织ＳＯＤ、ＭＤＡ、ＮＯ以及血浆ＤＡＯ含量,原位末端标记法（ＴＵＮＥＬ）观察肠黏膜细胞凋亡,细菌培养观察肠道细菌移位感染情况。结果　放射损伤模型制备成功,单纯照射组大鼠肠黏膜病理形态和结构较正常组明显损伤,小肠组织ＮＯ、ＭＤＡ含量与血浆ＤＡＯ含量均明显升高（Ｐ＜０.０５）,ＳＯＤ活性明显下降（Ｐ＜０.０５）,细胞凋亡指数和细菌感染率明显升高（Ｐ＜０.０５）。与单纯照射组相比,蜂胶处理后明显改善大鼠肠黏膜病理损伤,抑制小肠组织ＮＯ、ＭＤＡ含量和血浆ＤＡＯ含量升高（Ｐ＜０.０５）,提高组织ＳＯＤ活性（Ｐ＜０.０５）,并使细胞凋亡指数和细菌感染率明显下降（Ｐ＜０.０５）。结论　蜂胶在减轻大鼠放射性肠黏膜损伤和维持黏膜屏障功能方面有一定作用。     

鼻咽癌放疗后复发再程调强放疗的疗效分析

目的　研究鼻咽癌放疗后复发再程调强放疗的疗效及影响预后的因素。方法　回顾性分析６２例鼻咽癌放疗后复发患者,男性４６例,女性１８例,中位年龄４９岁（３７～６５岁）,中位复发时间为２５个月（１０～５７个月）。全组患者均行调强放疗,肿瘤靶体积ＧＴＶ总剂量为６０～７０Ｇｙ,每次分割剂量１.８～２.３Ｇｙ。结果　全组患者的中位随访时间为１４个月,１、３年生存率分别为６２.２％和４１.８％。至随访截止日期,死亡２８例,再复发３例,再复发同时转移２例,转移５例。单因素分析结果显示,仅化疗（Ｐ＝０.００３）与生存期相关;多因素分析提示,化疗（Ｐ＝０.０００）和ＧＴＶ体积（Ｐ＝０.０１９）是影响复发鼻咽癌的独立预后因素。毒副反应可耐受。结论　鼻咽癌放疗后复发患者再程调强放疗有效、可靠,化疗与ＧＴＶ体积是影响预后的主要因素。     

Ｓｕｒｖｉｖｉｎ在喉鳞癌中的表达及其与肿瘤细胞增殖和凋亡的关系*

目的　分析Ｓｕｒｖｉｖｉｎ在喉鳞癌中的表达及其与肿瘤细胞增殖、凋亡的关系,并探讨其与喉鳞癌临床病理特征之间的关系。方法　应用免疫组化染色技术检测Ｓｕｒｖｉｖｉｎ和Ｋｉ-６７在８６例喉鳞癌组织及３２例正常喉黏膜上皮组织中的表达;ＴＵＮＥＬ法检测喉鳞癌细胞的凋亡情况。结果　Ｓｕｒｖｉｖｉｎ在喉鳞癌组织中阳性表达率为６０.５％,高于正常喉黏膜上皮组织的１２.５％（Ｐ＜０.０５）,Ｓｕｒｖｉｖｉｎ阳性表达率与肿瘤临床分期、病理分级、淋巴结转移有关（Ｐ＜０.０５）;喉鳞癌Ｓｕｒｖｉｖｉｎ阳性组中凋亡指数（ＡＩ）低于阴性组（Ｐ＜０.０５）,增殖指数（ＰＩ）高于阴性组（Ｐ＜０.０５）,且Ｓｕｒｖｉｖｉｎ表达与ＡＩ呈负相关（ｒ＝－０.８３１,Ｐ＜０.０５）,与ＰＩ呈正相关（ｒ＝０.８８３,Ｐ＜０.０５）。结论　Ｓｕｒｖｉｖｉｎ在喉鳞癌中高表达,可能与喉鳞癌细胞的增殖和凋亡均有一定的关联。     

瘦素和瘦素功能性受体在非小细胞肺癌组织中的表达及其临床意义

目的　研究瘦素（ＯＢ）和瘦素功能性受体（ＯＢ-Ｒｂ）在非小细胞肺癌（ＮＳＣＬＣ）组织中的表达情况,探讨其表达水平与ＮＳＣＬＣ发生、发展及预后的关系。方法　采用免疫组化染色法检测１００例ＮＳＣＬＣ组织以及正常肺组织中ＯＢ和ＯＢ-Ｒｂ的表达,并研究其表达水平与临床病理参数之间的关系,运用单因素和多因素分析其与预后的关系。结果　ＯＢ在ＮＳＣＬＣ组织和正常肺组织的阳性表达率分别为７１％和２６％ （Ｐ＜０.０5）,ＯＢ-Ｒｂ则分别为６２％和３１％ （Ｐ＜０.０５）,ＨＥＲ-２在ＮＳＣＬＣ组织和正常肺组织的过度表达率分别为５４％和０（Ｐ＜０.０５）,三者在ＮＳＣＬＣ中的表达无明显相关性（Ｐ＞０.０５）。ＯＢ、ＯＢ-Ｒｂ和ＨＥＲ-２的表达与本组ＮＳＣＬＣ患者性别、年龄、吸烟史、病理类型均无关（Ｐ＞０.０５）;ＨＥＲ-２的表达与ＴＮＭ分期有相关性（Ｐ＜０.０５）;ＯＢ及ＨＥＲ-２的表达与淋巴转移有相关性（Ｐ＜０.０５）。单因素分析显示,ＮＳＣＬＣ患者性别、年龄、吸烟史和组织病理类型对预后无影响（Ｐ＞０.０５）,而ＴＮＭ分期、淋巴结转移、ＯＢ、ＯＢ-Ｒｂ和ＨＥＲ-２表达均对患者预后有显著影响（Ｐ＜０.０５）,ＯＢ、ＯＢ-Ｒｂ表达阳性以及ＨＥＲ-２过度表达的患者生存期明显缩短。Ｃｏｘ多因素分析显示,ＯＢ表达和淋巴结转移是影响ＮＳＣＬＣ患者预后的独立因子（Ｐ＝０.０００）。结论　ＯＢ、ＯＢ-Ｒｂ和ＨＥＲ-２在ＮＳＣＬＣ组织中高表达,ＯＢ、ＯＢ-Ｒｂ和ＨＥＲ-２表达高低可以作为区分组织良恶性的指标。ＯＢ、ＯＢ-Ｒｂ表达阳性以及ＨＥＲ-２过度表达的患者生存期明显缩短,ＯＢ表达情况可以作为判断ＮＳＣＬＣ患者预后的参考指标。     

促血管生成素在大肠癌组织的表达及其临床病理意义

目的　观察促血管生成素（Ａｎｇ）-１、Ａｎｇ-２及其受体Ｔｉｅ-２在大肠癌中的表达,探讨其与大肠癌血管生成的关系及临床病理意义。方法　采用免疫组化ＰＶ-９０００二步法观察５０例大肠癌和１０例正常大肠黏膜组织中Ａｎｇ-１、Ａｎｇ-２、Ｔｉｅ-２的表达,采用ＣＤ１０５标记检测微血管密度（ＭＶＤ）。结果　大肠癌组织Ａｎｇ-１的表达低于正常大肠黏膜,Ａｎｇ-２、Ｔｉｅ-２的表达高于正常大肠黏膜,差异均有统计学意义（Ｐ＜０.０５）;Ａｎｇ-１、Ａｎｇ-２的表达在不同分化程度间差异有统计学意义（Ｐ＜０.０１）;Ａｎｇ-１在淋巴结转移组的表达低于无转移组（Ｐ＜０.０５）;Ａｎｇ-２在淋巴结转移组高于无转移组（Ｐ＜０.０５）,在Ｄｕｋｅｓ'Ｃ、Ｄ期明显高于Ｄｕｋｅｓ'Ａ、Ｂ期（Ｐ＜０.０１）;Ｔｉｅ-２在淋巴结转移组的表达高于无转移组（Ｐ＜０.０５）;Ａｎｇ-２、Ｔｉｅ-２的表达与ＭＶＤ均呈正相关（ｒ＝０.３４５,Ｐ＜０.０５;ｒ＝０.２９９,Ｐ＜０.０５）。结论　促血管生成素与大肠癌的病理分化程度、Ｄｕｋｅｓ分期、淋巴结转移有关,并且在大肠癌血管生成过程中发挥重要作用。     

胃癌组织ＢＡＧ１蛋白表达与临床病理因素关系的研究

目的　研究抗凋亡基因ＢＡＧ１在胃癌组织中的表达及其与临床病理因素的关系。方法　应用免疫组织化学ＳＰ法对６２例胃癌组织和１１例正常胃组织中ＢＡＧ１蛋白表达进行检测。结果　胃癌组织中ＢＡＧ１蛋白阳性表达率为４１.９４％,显著高于胃正常组织的９.０９％ （Ｐ＝０.０４６）;ＢＡＧ１在胃癌组织中的表达与患者性别、年龄、肿瘤直径、肿瘤发生的部位及浸润深度无关（Ｐ＞０.０５）,但与胃癌病理分级、有无淋巴结转移及预后密切相关（Ｐ＜０.０５）。结论　胃癌组织中存在不同水平ＢＡＧ１蛋白的高表达,对疾病的预后有着重要意义。     

Postrelapse survival in osteosarcoma of the extremities: prognostic factors for long-term survival.

PURPOSE: To identify factors that influence postrelapse survival (PRS) in patients with nonmetastatic osteosarcoma of the extremity. PATIENTS AND METHODS: One hundred sixty-two patients with recurrent osteosarcoma of the extremity were retrospectively reviewed. The first-line treatment included surgery of the primary lesion and chemotherapy with methotrexate, doxorubicin, cisplatin, and ifosfamide. RESULTS: The projected 5-year PRS rate was 28%. Patients who had complete surgery of recurrence had a 5-year PRS of 39%, whereas for those who did not have complete surgery, PRS was 0% at 3 years (P <.0001). In the latter group, PRS was not influenced by site of recurrence and relapse-free interval (RFI), although it was influenced (P =.006) by the use of second-line chemotherapy (PRS, 53% at 12 months for patients who received chemotherapy v 12% for those who did not). In patients who had complete surgery, PRS was influenced by site of relapse (5-year PRS, lung 44%, other 19%; P <.06), RFI (5-year PRS at < or = 24 months, 20%; at > 24 months, 60%; P <.0001), and number of lung metastases (5-year PRS, two or fewer nodules, 59%; more than two nodules, 14%; P <.0001) but not by the use of a second-line chemotherapy treatment. CONCLUSION: RFI, site of metastases, and number of pulmonary nodules are the main prognostic factors for PRS in osteosarcoma. Complete surgery of recurrence is pivotal in the strategy of treatment. Patients with unresectable recurrence benefit from second-line chemotherapy, whereas our data do not support a generalized use of chemotherapy after complete surgery of first recurrence.     

Outcome after local recurrence of osteosarcoma: the St. Jude Children's Research Hospital experience (1970-2000)

BACKGROUND: Despite improvements in therapy for osteosarcoma, approximately 4-10% of patients experience a local recurrence and have a poor prognosis. METHODS: The authors analyzed prognostic factors for survival in 26 patients with a local recurrence of osteosarcoma who were treated between 1970 and 2000. RESULTS: The initial surgical procedure was amputation in 20 patients (76.9%) and limb salvage in 6 patients (23.1%). The median time from the diagnosis of osteosarcoma to local recurrence was 1.2 years (range, 1.2 months-6.1 years). Eleven patients (42.3%) developed an isolated local recurrence and 15 patients (57.7%) developed local and distant recurrence. The 5-year estimate of postrecurrence survival (PRS) (+/- 1 standard error) for the 26 patients was 19.2% +/- 7.7%. Recurrence > or = 2 years from the time of diagnosis was found to predict a better outcome (5-year PRS of 50.0% +/- 20.4%) compared with earlier recurrence (10.0% +/- 5.5%) (P = 0.037). Patients with negative margins after initial surgery were found to have improved survival (5-year PRS of 33.3% +/- 13.6%) compared with patients with positive margins (7.1% +/- 4.9%) (P = 0.015). Patients who underwent complete surgical resection at the time of recurrence were found to have a better PRS (5-year PRS of 41.7% +/- 14.2%) compared with patients who did not undergo surgery (0% +/- 0%) (P < 0.001). CONCLUSIONS: The prognosis for patients after local recurrence of osteosarcoma is poor. Complete surgical resection at the time of recurrence is essential for survival. Positive margins at the time of initial surgical resection and early recurrence appear to be poor prognostic factors.     

局部复发性骨肉瘤56例患者的预后因素分析

目的:探讨影响局部复发性骨肉瘤患者预后的相关因素.方法:2002年1月-2009年12月本科共收治并确诊骨肉瘤患者339例,回顾性分析其中56例局部复发性骨肉瘤患者的临床资料,并对其预后进行随访,随访时间为13～130个月,平均45.1个月.以性别、年龄、肿瘤部位、肿瘤大小、手术方式、新辅助化疗、第1次术后辅助化疗次数、肺转移、其他部位远处转移和局部复发后治疗这10项因素作为变量,应用Kaplan-Meier法计算患者总生存率和复发后生存率,应用log-rank检验进行预后的单因素分析,应用COX回归模型进行预后的多因素分析.结果:56例局部复发性骨肉瘤患者局部复发后的中位生存时间29个月(95％可信区间:24.5～33.5),总的中位生存时间为51个月(95％可信区间:29.3～72.7),累计2年和3年生存率分别为78.6％和46.4％.单因素分析显示,性别、肿瘤大小、肺以外其他部位转移和局部复发后治疗方案是局部复发性骨肉瘤的预后因素(P＜0.05);多因素分析显示,肺以外其他部位转移和局部复发后治疗方案是影响预后的独立相关因素(P＜0.05).年龄、肿瘤部位、手术方式、新辅助化疗、第1次术后辅助化疗和肺转移与复发性骨肉瘤的预后无关(P＞0.05).结论:肺以外其他部位转移和局部复发后治疗是影响局部复发性骨肉瘤患者预后的独立影响因素,对局部复发灶和远处转移灶采用积极的外科治疗能够有效地提高局部复发性骨肉瘤患者的生存率.     

支气管残端阳性非小细胞肺癌的预后分析

目的探讨手术切除的支气管残端阳性非小细胞肺癌（NSCLC）患者的预后影响因素。方法回顾性分析105例支气管残端阳性NSCLC患者的临床资料,并分析影响其预后的临床病理因素。结果支气管残端阳性NSCLC总体1、3及5年生存率分别为68.7%、39.7%及21.4%。单因素分析显示：气管镜活检是否阳性（P=0.010）、病理类型（P=0.000）、手术方式（P=0.001）、淋巴结清扫组数（P=0.018）等因素对患者生存率有显著影响;进一步行多因素分析显示：病理类型和手术方式是支气管残端阳性NSCLC独立的预后影响因素。结论残端阳性患者的预后总体较差,病理类型和手术方式是此类患者预后的独立影响因素,因此残端阳性要辅以综合治疗,以减少局部复发及远处转移,从而改善残端阳性患者的预后。     

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.     

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.     

脑转移瘤1448例临床资料分析

背景与目的：随着医疗技术的进步,肿瘤患者生存时间延长,脑转移瘤的发病率明显上升,但总体预后还很差,关于治疗模式的选择还存在很大的争议。本文总结中山大学肿瘤防治中心脑转移瘤患者临床资料,分析疾病特点以及与预后相关的各种可能因素,旨在为脑转移瘤的诊治提供参考。方法：收集1984年1月至2010年7月在中山大学肿瘤防治中心治疗经影像学或病理诊断的脑转移瘤患者的临床资料。总结所有可能与患者预后相关的因素,包括：患者的基本信息,原发灶的诊治情况,有无脑外转移灶,原发灶与脑转移瘤诊断的间隔时间,诊断依据,临床表现,病灶大小、部位、数目,治疗方法,KPS评分等。根据上述资料,将患者纳入RPAⅠ、Ⅱ、Ⅲ级3个亚组,进行生存分析。结果：共收集到1448例脑转移瘤患者,男性953例（65.8%）,女性495例（34.2%）,诊断为脑转移瘤时的中位年龄为55岁。原发灶中,肺癌1173例（81.0%）、乳腺癌84例（5.8%）、结直肠癌43例（3.0%）、肝癌23例（1.6%）。457例（39.8%）患者在诊断脑转移瘤之前存在脑外转移灶,原发灶与脑转移诊断的平均间隔时间为8.7个月。898例（62.0%）患者诊断依据为颅脑MRI,524例（36.2%）为颅脑CT,26例（1.8%）为PET-CT。944例（65.2%）患者的转移灶位于幕上,其中额叶及顶叶最为常见;单发病灶522例（36%）,201例（13.9%）具有两个病灶,621例（42.9%）具有两个以上病灶。临床表现中,头痛呕吐378例（26.1%）,运动感觉障碍364例（25.1%）,精神变差或体重下降230例（16.0%）,无症状203例（14.0%）。379例（26.1%）患者接受了全脑放疗联合化疗,110例（7.6%）接受了单纯全脑放疗,23例（1.6%）全脑放疗后联合手术,42例（2.9%）联合立体定向放射外科治疗。107例（7.4%）患者接受了手术治疗。854例患者具有完整的生存随访资料,中位生存时间为9.5个月;6个月、12个月、24个月累计生存率分别为71.7%、42.5%、12.6%。RPAⅠ级264例（30.9%）、Ⅱ级377例（44.2%）、Ⅲ级213例（24.9%）3组患者的中位生存时间分别为11个月、10.5个月和6.5个月,组间差异有统计学意义（P〈0.001）。结论：脑转移瘤常多发,转移灶多见于幕上,头颅MRI是主要的诊断方法;原发灶以肺癌最多见;RPA分级在评估脑转移瘤患者预后中有重要意义;坚持在循证医学指导下的个体化治疗的原则,有希望改善脑转移瘤患者的预后。     

Prognostic factors in high-grade osteosarcoma of the extremities or trunk: an analysis of 1,702 patients treated on neoadjuvant cooperative osteosarcoma study group protocols.

PURPOSE: To define prognostic factors for response and long-term outcome for a wide spectrum of osteosarcomas, extending well beyond those of the typical young patient with seemingly localized extremity disease. PATIENTS AND METHODS: A total of 1,702 consecutive newly diagnosed patients with high-grade osteosarcoma of the trunk or limbs registered into the neoadjuvant studies of the Cooperative Osteosarcoma Study Group before July 1998 were entered into an analysis of demographic, tumor-related, and treatment-related variables, response, and survival. The intended therapeutic strategy included preoperative and postoperative chemotherapy with multiple agents as well as surgery of all operable lesions. RESULTS: Axial tumor site, male sex, and a long history of symptoms were associated with poor response to chemotherapy in univariate and multivariate analysis. Actuarial 10-year overall and event-free survival rates were 59.8% and 48.9%. Among the variables assessable at diagnosis, patient age (actuarial 10-year survival > or = 40, 41.6%; < 40, 60.2%; P =.012), tumor site (axial, 29.2%; limb, 61.7%; P <.0001), and primary metastases (yes, 26.7%; no, 64.4%; P <.0001), and for extremity osteosarcomas, also size (> or = one third, 52.5%; < one third, 66.7%; P <.0001) and location within the limb (proximal, 49.3%; other, 63.9%; P <.0001), had significant influence on outcome. Two additional important prognostic factors were treatment related: response to chemotherapy (poor, 47.2%; good, 73.4%; P <.0001) and the extent of surgery (incomplete, 14.6%; macroscopically complete, 64.8%; P <.0001). All factors except age maintained their significance in multivariate testing, with surgical remission and histologic response emerging as the key prognostic factors. CONCLUSION: Tumor site and size, primary metastases, response to chemotherapy, and surgical remission are of independent prognostic value in osteosarcoma.     

Prognostic factors for soft tissue sarcoma patients with lung metastases only who are receiving first‐line chemotherapy: An exploratory,retrospective analysis of the European Organization for Research and Treatment of Cancer‐Soft Tissue and Bone Sarcoma Group (EORTC‐STBSG)

The prognosis of adult soft tissue sarcoma (STS) patients with metastases is generally poor. As little is known about the impact of the involvement of different metastatic sites and the extent of pulmonary lesions on the outcome for patients receiving first‐line chemotherapy, we aimed to establish prognostic factors for STS patients with lung metastases only. A retrospective, exploratory analysis was performed on 2,913 metastatic STS patients who received first‐line chemotherapy. Detailed information from 580 patients who had lung metastases only, was used for prognostic factor analysis. Patients with lung metastases only were more often asymptomatic and had undergone complete primary tumor resection more frequently compared to patients with additional metastases outside the lung or without lung metastases. For extremity STS, the incidence of lung metastases only was much higher compared to non‐extremity STS. Lung involvement only was an independent favorable prognostic factor for overall survival (OS) with regard to metastatic site. Within this subgroup, in a multivariate model, other factors associated with improved OS included: good performance status (PS), no progression at primary site, low histological grade, younger age, long interval between initial diagnosis and trial registration, and smaller diameter of the largest lung lesion. This unique analysis on prognostic factors in STS patients with lung metastases confirms well‐known patient factors (such as age and PS), and tumor characteristics (including tumor grade, interval between primary diagnosis, and metastases), but also identifies diameter of the largest lung lesion as a new prognostic factor. Knowledge about these factors may support decision‐making within multidisciplinary tumor boards.     

肿瘤型人工膝关节置换治疗儿童股骨远端骨肉瘤

目的评估使用肿瘤型人工膝关节置换治疗儿童股骨远端骨肉瘤的治疗效果。方法2003年12月至2008年12月,36例14岁以下股骨远端骨肉瘤儿童患者行肿瘤型人工膝关节置换手术,31例随访数据完整。患者年龄9～14岁,平均12．3±1．6岁。男11例,女20例。所有患者都是未经治疗的IIB期原发骨肉瘤。所有患者都经过标准术前化疗、肿瘤型人工膝关节置换手术及术后化疗。结果手术使用普通单纯铰链式膝关节8例,普通旋转铰链式膝关节11例,特制远端非水泥固定铰链式膝关节12例。边缘切除9例,广泛切除22例。31例患者随访12～75个月,中位随访时间26个月,平均32个月。随访期间死亡13例,存活18例,无瘤生存16例,带瘤生存2例。Kaplan—Meier生存分析显示2年生存率74．1％,3年生存率44．6％。局部复发2例（6．5％）。转移14例（45．2％）,其中肺转移10例（32．3％）,软组织或骨转移3例（9．7％）,肺转移合并软组织转移或骨转移1例（3．2％）。存活且未截肢患者15例,MSTS功能评分平均21．5±4．7分,肢体功能优良率86．7％。三种假体术后功能比较,差异无显著性（P=0．979）。随访期内假体并发症发生率38．7％,其中假体周围感染2例（6．5％）,假体松动10例（32．3％）。特制远端非水泥固定铰链式关节并发症低于常规使用关节。结论在标准治疗后,肺转移是导致儿童骨肉瘤患者死亡的主要原因;外科边界与局部复发关系密切,提高保肢的安全性需恰当地选择外科边界;特制远端非水泥固定铰链式人工假体与常规使用人工假体功能无明显差异,并不增加早期并发症发生率。