成人骨肉瘤的临床特点及预后影响因素

目的 分析成人骨肉瘤患者的临床与治疗特点,探讨预后相关因素.方法 回顾性总结2003年3月至2005年3月间收治并确诊为骨肉瘤的30例40岁以上成年患者的病例资料,以性别、年龄、肿瘤生长部位、肿瘤大小、血清碱性磷酸酶水平、影像学表现、病理骨折、组织学分级、术前诊断正确性、Enneking外科分期、手术方式、化疗、远处转移13项因素为变量指标,应用Kaplan-Meier法测算生存率,应用Los-rank检验行单因素分析,应用Cox回归模型行多因素分析,检验研究这些因素与3年生存率之间的关系.结果 所有30例患者均得到随访,存活17例,随访时间36～60个月,平均41个月;死亡13例,死亡时间为术后3～35个月,平均16个月,3年生存率56.7%.30例患者中四肢骨20例,中轴骨lO例;血清碱性磷酸酶水平22例正常,8例升高;影像学表现溶骨型17例,混合型8例,成骨型5例.3年生存率与年龄、肿瘤生长部位、血清AKP水平、Enneking外科分期、手术方式、远处转移相关(单因素P值<0.05),其中仅手术方式为独立相关影响因素(多因素P值<0.05),而与性别、肿瘤大小、影像学表现、病理骨折、组织学分级、化疗及术前诊断正确性无相关关系(P>0.05).结论 成人骨肉瘤临床表现较年轻患者更好发于中轴骨,血清AKP水平多正常,影像学多见溶骨型改变.其预后与手术方式密切相关.成人骨肉瘤的治疗应当建立在充分切除肿瘤的基础上,以期改善预后.

The diuleal features and prognostic factors of osteosarcoma in adult

Objective To study clinical features and outcomes of adult osteosareoma patients and evaluate prognostic factors for survival. Methods The clinical data of 30 patients over 40 years old of os-teosarcoma were retrospectively reviewed between March 2003 and March 2005, which included sex, age, tumor site, et al. Kaplan-Meier method was used to measure the overall survival rate. And log-rank univari-ate analysis was used to find prognostic factors related with survival rate. And Cox model multivariate analy-sis was used to find which prognostic factor was the independent one. Results All the patients were fol-lowed up at least 3 years, and 13 patient died with a median survival of 16months (range, 3-35 months) . Overall surviral rate was 56.7%. The tumors were at extremitities in 20 cases and axial bones in 10 cases. In X-ray film, 17 cases showed osteolytic lesions, 8 showed mixed, and 5 showed osteoblastic lesions. There were 22 cases with normal serum AKP levels, and 8 cases with higher levels of serum AKP. Overall surviral rate of 3 years was significantly related to patients" age, tumor site, serum AKP level, Enneking surgical stage, surgical method and distant metastasis (Log-rank, P<0.05), and surgical method was the independent prognostic factor(Cox model, P<0.05). Other factors, such as sex, tumor size, radiological finding, pathological fracture, histopathology grade, correct preoperative diagnosis, chemotherapy were unrelated with the overall surviral rate (P>0.05). Coulusion The clinical features of adult patients with osteosareoma was different from the young. There were more cases with tumor on axial bones in adult, and more cases with a normal serum AKP level, and osteolytic radiological finding. Surgical method played an important role in prognosis for survival in adult osteosarcoma patients.