95例ⅡB期肢体骨肉瘤生存分析—新辅助化疗结合区域动脉灌注疗效探讨

目的探讨术前新辅助化疗次数、区域动脉灌注化疗对骨肉瘤临床近期疗效及预后的影响。方法术前无远处转移的ⅡB期肢体骨肉瘤随访95例，随机分为新辅助化疗组和术后辅助化疗组。新辅助化疗组51例，其中加用动脉灌注化疗17例。新辅助化疗组术前化疗1．3个疗程，主要药物为MTX、DDP、IFO、EPI，动脉灌注化疗加用顺铂和表阿霉素灌注化疗1次。评价新辅助化疗组、术后辅助化疗组、新辅助化疗组中加用动脉灌注组间的疗效差异。结果随访满2年的79例患者中位生存期为53．0个月（95％CI18．08～87．92），无病中位生存期为17．0个月（95％CI9．33～24．67）。新辅助化疗组的中位无病生存时间及中位生存时间均高于术后辅助化疗组，两组生存函数差异有统计学意义。加用灌注化疗的患者保肢率81．25％，远高于不加灌注化疗者，差异有统计学意义。结论新辅助化疗的实施提高了ⅡB期骨肉瘤患者的2年无病生存率及总生存率。是改善ⅡB期骨肉瘤患者预后的理想方法。动脉灌注化疗可以增加保肢几率，改善近期疗效，但对患者的远期生存影响无统计学意义。

Survival analysis of 95 patients with stage II limb osteoscarcoma: a randomized trial with the addition of neoadjuvant chemotherapy and artery chemotherapy and artery chemotherapy

Objective To investigate the therapeutie effect of a neoadjuvant chemotherapy combined with regional artery fusion on osteosarcoma and its affect on prognosis. Methods Ninety-five patients who had stage ⅡB limb osteosarcoma without distant metastasis before surgery were followed up. They were divided into the neoadjuvant chemotherapy group and post-operative chemotherapy group. There were 51 patients in the chemotherapy group, 17 of whom also underwent artery infusion. All 51 patients have undergone 1 to 3 eourses of treatment. The major chemotherapeutic drugs are MTX, DDP, IFO, EPI. The 17 patients also underwent artery infusion combined with eisplatin and epirubicin infusion for once. The differences among the therapeutic effect of the neoadjuvant chemotherapy group, post-operative chemotherapy group and the neoadjuvant chemotherapy group with cisplatin and epirubiein infusion were explored. Results Seventy-nine patients were followed up for 2 years. The median survival period was 53.0 months （95%CI18.08- 87.92）, and the disease-free median survival period was 17.0 months （95%C19.33 - 24.67）. The median survival period and the disease-free median survival period in the neoadjuvant chemotherapy group are both higher than those of the post-operative chemotherapy group. The survival function difference between these two groups has statistical significance. The limbsalvage rate was 81.25% in the neoadjuvant chemotherapy group with eisplatin and epirubicin infusion which was much higher than those in the non-infusion group. The difference has statistical significance. Conclusions The implementation of the neoadjuvant chemotherapy elevated the 2-year disease-free survival rate and the general survival rate. It is an effective way to improve the prognosis of patients with osteosarcoma. Artery infusion can increase the limb-salvage rate, improve the short-term effect, but has no statistical significance to long-term effect.