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.

Retrospective analysis of prognostic factors for 56 patients with local recurrent osteosarcoma

Objective: To identify the prognostic factors related to local recurrent osteosarcoma. Methods: The clinical records of 56 patients with local recurrent osteosarcoma from 339 patients with identified osteosarcoma between January 2002 and December 2009 were retrospectively reviewed, and these patients were followed-up for 13-130 months with an average follow-up period of 45.1 months. The factors of gender, age, tumor site, tumor size, operation process, neoadjuvant chemotherapy, cycles of adjuvant chemotherapy after primary operation, lung metastasis, metastasis of other sites (not lung),and treatment after local recurrence were selected as the measurements for analysis. Kaplan-Meier method was used to calculate the overall survival and post-recurrence survival. The univariate analysis of prognosis was performed by log-rank test, and the multivariate analysis of prognosis was performed by COX regression model. Results: The median post-recurrence survival and overall survival of 56 patients were 29 months (95% confidence interval: 24.5-33.5) and 51 months (95% confidence interval: 29.3-72.7), respectively. The 2- and 3-year cumulative survival rates were 78.6% and 46.4%, respectively. The univariate analysis showed that the significant prognostic factors included gender, tumor size, metastasis of other sites (not lung) and treatment after local recurrence (P < 0.05). The COX regression analysis revealed that metastasis of other sites (not lung) and treatment after local recurrence were independent prognostic factors (P < 0.05). The prognosis of local recurrent osteosarcoma was not associated with age, tumor site, operation process, neoadjuvant chemotherapy, and adjuvant chemotherapy after primary operation (P > 0.05). Conclusion: The independent prognostic factors for local recurrent osteosarcoma were metastasis of other sites (not lung) and treatment after local recurrence. The aggressive surgical treatment for local recurrence and distant metastasis can effectively improve the survival of local recurrent osteosarcoma.