骨盆尤文肉瘤31例治疗结果分析  

Ewing＇s sarcoma of the pelvis： treatment results of 31 patients

作　　者：臧杰[1] 郭卫[1] 曲华毅[1] 

机构地区：[1]北京大学人民医院骨肿瘤科,100044

出　　处：《中华外科杂志》2012年第6期524-528,共5页Chinese Journal of Surgery

摘　　要：目的了解骨盆尤文肉瘤综合治疗的肿瘤学和功能学的预后。方法回顾性分析2001年7月至2008年7月符合人选标准的31例初治的骨盆原发尤文肉瘤的患者资料，其中原发肺转移10例。所有患者都接受了包括新辅助化疗、手术以及术后辅助放疗的综合治疗措施。28例患者接受了保肢手术，3例患者接受半盆离断术。对治疗的并发症进行记录，同时应用国际保肢学会功能评分（MSTS）93标准进行功能评分。对观察指标进行Kaplan—Meier生存分析，Log—rank检验显著性，对有显著差异的因素进行Cox多因素分析。结果随访时间为13～121个月，平均46．8个月。5年整体生存率为42．3％。在单因素分析中，肿瘤直径〈10cm（x2=4．382）、外科分期为ⅡB期（x2=4．521）、获得广泛性切除（x2=4．851）的患者预后较好（P〈0．05）；在多因素分析中，肿瘤分期（RR=2．480，95％CI：0．857～7．173）和切除的外科边界（RR=2．576，95％CI：0．474～14．011）是影响预后的独立危险因素。采用MSTS93标准对患者的功能进行评分，平均分为63．3％，并发症的发生率为29．0％（9／31）。结论对于骨盆尤文肉瘤，外科分期、切除的外科边界是影响预后的独立危险因素。就诊时出现转移和（或）切缘阳性的患者应该采取更为积极的治疗。外科手术产生了一定的功能障碍，但是患者经过康复治疗，多数患者能够取得较满意的功能评分。Objective To define oncologic and functional outcomes of multidisciplinary treatment methods combined chemotherapy, surgery and radiotherapy, patients with Ewing＇s sarcoma of the pelvis who were treated at our center were analyzed. Methods Thirty-one patients with Ewing＇s sarcoma of the pelvis were eligible for this analysis. Primary lung metastases occurred in ten patients who were classified as stage Ⅲ according to the system of Musculoskeletal Tumor Society （MSTS）. All the patients received multidisciplinary treatment methods combined chemotherapy, surgery and radiotherapy. Twenty-eight patients underwent limb-sparing surgery, three patients underwent hemipelvectomy. The complications, including radiation or surgery-related complications and mechanical failures were recorded, besides the functional results were evaluated according to the MSTS 93 criteria. Kaplan-Meier survival analysis and Cox multivariate analysis were used as statistical methods. Results The 5-year overall survival （OS） rate for all the patients was 42.3%. The 5-year OS for patients with small tumor （ 〈 10 cm） had a significant better prognosis than patients with large tumor （≥10 cm, 58.2% vs. 26. 0%, X2 =4.382, P〈0.05）. The 5-year OS for patients with surgical stage Ⅱ b was significantly better than for those with surgical stage Ⅲ （50. 2% vs. 30. 3% , X2 =4. 521, P 〈0. 05）. The 5-year OS for patients with wide or radical surgery had a better prognosis than patients with marginal, intralesional surgery or no surgery （60. 0% vs. 29.4% , X2 = 4. 851, P 〈 0. 05 ）. In multivariate analysis, surgical stageⅢ （ RR = 2. 480, 95 % CI： 0. 857-7. 173 ） and resection margin （RR = 2. 576, 95% CI： O. 474-14. 011 ） were independent prognostic factors. The mean MSTS 93 score for all the patients was 63.3%. The complication rate in patients treated with surgery was 29.0% （9/31）. Conclusions Patients with Ewing＇sareoma of the pelvis can benefit from muhidisciplinary treatment in terms of improved

关 键 词：肉瘤 Ewing 骨肿瘤 骨盆 存活率 综合疗法 治疗结果 

分 类 号：R738.1[医药卫生—肿瘤]