单中心四肢骨肉瘤311例预后分析

 目的 探讨单中心四肢骨肉瘤的治疗、预后及生存状况。方法 回顾性分析1998年至2008年间单中心收治的311例四肢骨肉瘤患者的病历资料，记录患者的基本资料、化疗、手术、并发症、肿瘤转移及预后情况，应用Kaplan-Meier、Cox regression 等统计学方法分析各变量与预后生存的关系。结果 311例四肢骨肉瘤患者，男206例，女105例；年龄5～56岁，平均18.6岁；上肢29例，下肢282例。282例获得广泛或根治性手术，保肢手术149例，截肢手术133例。术后64例患者发生各种并发症，其中17例出现2次以上的术后并发症，25例发生肿瘤局部复发。105例获得规范化疗，206例未获得规范化疗，5年生存率分别为57.4%和36.3%。肺转移患者(76例)和无肺转移患者5年生存率分别为16.8%和50.7%。Enneking 分期ⅡB期和Ⅲ期患者5年生存率分别为44.6%和33.1%。选择保肢手术和截肢手术患者的5年生存率分别为56.6%和31.8%，由于截肢患者中有较大的比例施行了不规范化疗以及其他混杂因素导致5年生存率明显降低。Cox回归分析显示化疗不规范和发生肺转移患者预后较差。结论 新辅助化疗联合肿瘤广泛或根治性手术切除可以挽救约60%青少年四肢骨肉瘤患者的生命，肺转移和不规范化疗严重影响患者的预后。

Survival analysis of 311 patients with osteosarcoma of the extremities treated in a single institute

Objective To investigate treatment and prognosis of patients with osteosarcoma of the extremities. Methods A total of 311 patients with osteosarcoma of the extremities, who had undergone treatment in our institute from 1998 to 2008, were enrolled in this retrospective study. Kaplan-Meier survival curve and Cox regression model were used to analyze the correlation between survival rate and variables including patients' demographics, chemotherapy, surgery, complications, and tumor metastasis. Results Among 311 patients, there were 206 males and 105 females, aged from 5 to 56 years (average, 18.6 years). A total of 282 patients underwent aggressive or radical surgery, including 149 cases of limb salvage surgery and 133 cases of amputation surgery. One hundred and five patients underwent standard chemotherapy and 206 patients underwent non-standard chemotherapy. The 5-year survival rate was 57.4% in patients treated with standard chemotherapy, 36.3% in patients treated with non-standard chemotherapy, 16.8% in patients with lung metastasis, 50.7% in patients without lung metastasis, 56.6% in patients who underwent limb salvage surgery, 31.8% in patients who underwent amputation surgery, 44.6% in patients with Enneking stage ⅡB and 33.1% in patients with Enneking stage Ⅲ. For patients treated by amputation surgery, because non-standard chemotherapy which was performed in most of them and other confounding factors, the 5-year survival rate of them was lower. The Cox regression analysis showed that lung metastasis and non-standard chemotherapy were associated with inferior outcomes. Conclusion Neoadjuvant chemotherapy combined with aggressive or radical surgery could cure about 60% of patients with osteosarcoma of the extremities. Lung metastasis and non-standard chemotherapy are risk factors that severely affect prognosis.