原发灶广泛切除术或截肢术对合并远处转移肢体软骨肉瘤患者总体生存时间的影响

目的 探讨采用原发灶广泛切除术或截肢术治疗的合并远处转移的肢体软骨肉瘤患者的总体生存时间。方法 搜集美国国立癌症研究院SEER数据库中1994—2013年在诊断时已发生远处转移的58例肢体软骨肉瘤患者的临床资料进行回顾性分析,根据原发灶的手术方式分为广泛切除组(43例)和截肢组(15例)。通过单因素Log-rank分析、多因素Cox比例风险模型比较不同手术方式对软骨肉瘤患者总体生存时间的影响。结果 58例合并远处转移的肢体软骨肉瘤患者中,男33例、女25例,中位年龄61(14~88岁)。肿瘤发生于上肢16例、下肢42例。单因素Log-rank分析结果表明,广泛切除或截肢对患者总体生存时间的影响差异无统计学意义(P=0.409)。手术方式和单因素Log-rank分析中P＜0.1的变量被纳入到多因素Cox分析中以校正混杂因素,结果仍显示广泛切除和截肢对患者总体生存时间的影响差异无统计学意义(相对于广泛切除术,截肢术危险度为1.646,95%可信区间为0.856~3.166, P＞0.05)。结论 针对原发灶进行广泛切除或截肢治疗对合并远处转移的肢体软骨肉瘤患者的总体生存时间没有显著差异。

The effect of primary tumor resection or amputation on overall survival in patients with metastatic extremity chondrosarcoma

Objective To compare overall survival of metastatic extremity patients treated with limb salvage and amputation. Methods Fifty-eight patients of extremity chondrosarcoma with distant metastasis were collected between 1994 and 2013 from Surveillance, Epidemiology, and End Results ( SEER) database for retrospective analyses. All the patients were classified as limb salvage group ( n = 43 ) or amputation group ( n = 15 ) according to surgery type. Univariate Log-rank analysis and multivariate Cox proportional hazard regression analysis were applied to compare overall survival in these two groups. Results Among 58 extremity chondrosarcoma patients, 33 patients were males, 25 patients were females, and the median age was 61 ( 14 - 88 years old ). Of the patients in the cohort, 16 patients had a tumor located in upper extremity, while 42 patients had a tumor located in lower extremity. There was no significant difference in overall survival between patients treated with limb salvage and amputation (P 二0.409) by univariate logrank analysis demonstrated. In addition, multivariate Cox regression analysis including surgery type, histologic subtype and tumor grade was performed to control confounding variables. The results of multivariate analysis still suggested that there was no difference in overall survival between patients treated with limb salvage and amputation (amputation: hazard ration = 1.646, 95% confidence interval = 0. 856 - 3. 166, P〉0. 05 ). Conclusions There is no significant difference in overall survival between patients treated with limb salvage and amputation.