AP化疗方案联合手术治疗原发性骨肉瘤的临床观察

目的探讨AP化疗方案联合手术治疗四肢原发性骨肉瘤的临床效果。方法回顾2008年1月至2011年11月，收治的四肢原发性骨肉瘤30例，病例资料及随访完整的20例患者纳人本研究，男12例，女8例；年龄9～38岁，平均19岁。发病部位：股骨远端10例，胫骨近端7例，肱骨近端3例。根据Enneking外科分期均为IIB期，术前穿刺活检病理亚型：成骨细胞型8例，成软骨细胞型6例，成纤维细胞型2例，小细胞性2例，毛细血管扩张型2例。20例患者均采用AP化疗方案联合手术治疗。结果随访时间12～55个月，平均35．6个月。20例中，保肢手术病例18例，截肢手术病例2例，手术即时保肢率为90％。7例因肺转移而死亡，其中5例死于术后2年内；2例分别在术后10、12个月复发，复发率为10％，末次随访时1例死亡，1例带瘤生存。Kaplan—Meier分析患者3年总生存率为66％。末次随访时规范化疗组12例中死亡3例，生存率为75％（9／12）；不规范化疗组8例中死亡4例，生存率为50％（4／8）。13例存活并保留肢体的患者末次随访时MSTS评分为23～27分，平均25．3分。结论AP化疗方案联合手术治疗四肢原发性骨肉瘤患者生存率和保肢率尚可，可以作为一种选择性应用的骨肉瘤化疗方案。

Clinical observation of AP chemotherapy protocol combined with surgery in the treatment of primary osteosarcoma

Objective To analyze the effect of AP chemotherapy protocol combined with surgery for primary osteosarcoma of bone in the extremities. Methods Between January 2008 and November 2011, a total of 30 patients were initially diagnosed as primary osteosarcoma of extremity. 20 patients with complete data and follow-up materials were collected. There were 12 males and 8 females. The average age of patients was 19 years （ range; 9-38 years ）. The distal femur was affected in 10 patients, the proximal tibia in 7 patients and the proximal humerus in 3 patients. According to Enneking staging classification, all of the patients were at stage IIB, Preoperative pathological subtypes diagnosed by biopsy were listed as follow： osteoblast in 8 patients, chondroblasts in 6, fibroblasts in 2, small cell in 2, and telangiectasis in 2. All of the patients were treated by AP chemotherapy protocol combined with surgery. Results The mean time of the follow-up was 35.6 months （ range; 12-55 months ）. Patients treated with limb-salvage surgery amounted for 18 cases and amputation for 2 cases respectively. The instant limb-salvage rate was 90%. 7 patients died of pulmonary metastasis, while 5 of which died within 2 years after the surgery. 2 patients experienced local recurrence at 10 months and 12 months after surgery respectively, with the recurrence rate of 10%. I of them died, and the other was still alive with tumors at final follow-up. The 3-year overall survival rate was 66% by Kaplan-Meier analysis. At final follow-up, 3 out of 12 cases died in the standard chemotherapy group and 4 out of 8 cases died in the non-standard chemotherapy group, with the survival rates were 75% and 50% respectively. The average Musculoskeletal Tumor Society （ MSTS ） score was 25.3 （ range, 23-27 ）. Conclusions The survival rate and limb-salvage rate are fairly satisfactory when combining AP chemotherapy protocol with surgery in the treatment of primary osteosarcoma of the bone. AP chemotherapy protocol is a practicable chemotherapy protocol for primary osteosarcoma of the bone.