Ⅲ期骨肉瘤的治疗  

The treatment of stage Ⅲ osteosarcoma

作　　者：叶招明[1] 李伟栩[1] 杨迪生[1] 陶惠民[1] 

机构地区：[1]浙江大学医学院附属第二医院骨科,杭州310009

出　　处：《中华骨科杂志》2005年第6期363-367,共5页Chinese Journal of Orthopaedics

摘　　要：目的探讨Ⅲ期骨肉瘤的诊断、治疗和预后。方法分析1989年12月至2003年12月收治的23例Ⅲ期肢体骨肉瘤患者,男14例,女9例;年龄16～31岁,平均22.4岁。肺转移15例,骨转移7例(跳跃转移5例,骨肉瘤病2例),同时存在肺和骨转移1例。经术前化疗,并行原发肿瘤和转移病灶的切除手术。结果经术前化疗,1例就诊时肺部有1个结节的患者转移瘤消失,1例同时存在肺和骨转移者,切除原发病灶后,出现多处转移,不能行转移灶切除手术;2例骨肉瘤病者仅切除原发病灶;5例跳跃转移者中的2例,切除原发和跳跃转移病灶后,各出现1个肺转移灶。16例行开胸术,其中6例再次出现肺转移灶而行二次开胸术,3例患者二次开胸术后出现肺外转移而放弃治疗。原发病灶与转移病灶的肿瘤坏死率差异无统计学意义。随访5～168个月(平均74.6个月),无瘤生存9例,带瘤生存4例,死亡10例。Cox模型分析提示转移病灶的数目与预后相关(P<0.05)。肺转移与跳跃转移病灶的Kaplan-Meier生存曲线经log-rank检验,差异无统计学意义。结论新辅助化疗及原发病灶和转移灶的手术切除是Ⅲ期骨肉瘤治疗的有效方法,首次肺转移灶切除采用胸骨正中切口,转移瘤的数目与预后相关。Objective To discuss the diagnosis, treatment and prognosis of stage Ⅲ osteosarcoma. Methods A retrospective analysis of 23 patients with stage Ⅲ osteosarcoma of extremities from December 1989 to December 2003 was studied. There were 9 females and 14 males, aging from 16 to 31 years with a mean of 22.4 years. 15 patients presented with lung metastases, 7 with bone metastases (including 5 of jumping metastases and 2 of osteosarcomas) and 1 with lung and bone metastases simultaneously. Patients received chemotherapy followed by resection of primary and metastatic lesions and additional chemotherapy. Results After preoperative chemotherapy, lung metastases disappeared in 1 patient, whereas in 1 with lung and bone metastases simultaneously, the lesion remained surgically unresectable because of new metastases after removal of the primary lesion. In 2 patients with osteosarcoma, primary lesion could only be removed, lung metastasis appeared in 2 of 5 patients with jumping metastases respectively after the removal of primary lesion and jumping metastases. 16 patients with lung metastases received thoracotomy and resection of the lung metastatic lesions, and 6 of them received a second thoracotomy because of a second lung metastasis inclunding 3 cases with extra-pulmonary metastases without any additional treatment. The tumor necrosis rate was not found obviously different between primary lesions and metastatic lesions. Of the 23 patients who achieved a mean 74.6 months follow-up (range, 5-168 months), 9 remained continuously free of disease, 4 relapsed with new metastases, and 10 died of tumors. The outcome of the Cox model proportional hazard regression showed the relation of the number of the metastases and the prognosis were significant(P<0.05). Using log-rank method, no obviously difference between the Kaplan-Meier survival curve of the patients with lung metastases and that of the jumping metastases was found. Conclusion The combination of neoadjuvant chemotherapy and resection of the primary and metastatic le

关 键 词：Ⅲ期 COX模型分析 转移病灶 原发病灶 肺转移灶 胸骨正中切口 跳跃转移 术前化疗 切除手术 预后相关 肢体骨肉瘤 2003年 1989年 二次开胸术 新辅助化疗 骨转移 方法分析 骨肉瘤病 原发肿瘤 放弃治疗 肺外转移 开胸术后 

分 类 号：R738.1[医药卫生—肿瘤]