我国骨肉瘤治疗现状及改进建议——17家骨肿瘤治疗中心1998～2008年资料分析

目的收集17家国内著名的骨肉瘤治疗科室的近5～10年资料，反映我国骨肉瘤治疗现状，阐明促成建立多中心前瞻性研究共识的重要性。方法17家医院2015例骨肉瘤患者，男性58％，女性42％；10—30岁患者占70．7％；肿瘤侵袭膝关节的病例占80％；Ⅱa期病例占1．5％-39．0％，平均10．8％；Ⅱb期病例占54％～100％，平均83％；Ⅲ期病例占2％～15％，平均8％。新辅助化疗病例64．7％～100．0％，平均77．0％，辅助化疗病例8．0％～35．3％，平均18．0％；保肢手术病例50％-100％，平均79％；截肢手术病例3％～50％，平均21％。结果随访2年以上，总生存率（OS）37．5％～77．6％（平均64．0％）；总缓解率（OR）80．0％～94．5％（平均86．0％）；无病生存率（DFS）34．81％～69．7％（平均56．0％）；无复发生存率（RFS）32．2％-81．5％（平均60．0％）。保肢率79％；复发率0．8％～22．0％（平均9．1％）；肺转移率9．0％～42．5％（平均24．8％）。结论我国治疗骨肉瘤的现状显示多学科综合治疗已成为多家治疗中心的共识。建立多中心前瞻性临床治疗研究是需要迫切解决的问题，具体包括规范的诊断、外科分期、化疗药物的选择、化疗疗效的评价、有效的复查机制。

The current status of the treatment for osteosarcoma in China

Objective To investigate and present osteosareoma treatment status during the past 5-10 years in 17 institutes in China and to clarify the importance of holding consensus on muhi-eentres prospective research. Methods A total of 2015 patients with osteosareoma were diagnosed and treated in 17 hospitals, with male accounting for 58% and female 42%. 70.7% of the patients aged between 10 to 30 years old; 80% of the patients were knee joint involved. Patients with stage Ⅱa amounts for 10.8% in average（ranging form 1.5% to 39.0%）; patients with stage Ⅱb amounts for 83% in average（ranging from 54% to 100%）; patients with stage Ⅲamounts 8% in average（range, 2% to 15%）. 77% of the patients （ranging from 64.7% to 100%） underwent neoadjuvant chemotherapy; and 18% of the patients （ranging 8% to 35.5%） underwent adjuvant chemotherapy. Patients who had limb-salvage surgery amount for 79% in average（ranging from 50% to 100%） and amputation 21% in average（ranging from 3% to 50%）. Results Two months overall survival was 64% in average（ranging from 37.5% to 77.6%） ; overall remission rate was 86% in average（ranging from 80% to 94.46%）; disease free survival was 56% in average（ranging from 34.81% to 69.73%）; relapse free survival was 60% in average（ranging from 32.2% to 81.5%）; limb-salvage rate was 79%; relapse rate was 9.1% in average（ranging from 0.8% to 22.0%）; lung metastasis rate was 24.8% in averageranging from 9.0% to 42.5%）. Conclusions This report presents current status of osteosarcoma treatment in China. Multi-discipline integrated treatment for osteosarcoma is consensus in many institutes. We focus on the importance and process of establishing multi-centres prospective clinical research. A series of standard schemes need to be found, including diagnosis, surgical staging, administrating and evaluation of chemotherapy and effective follow up.