413例骨肉瘤化疗、手术和预后的10年随访研究  

Ten-year follow-up of the chemotherapy,surgery and prognosis for 413 cases of osteosarcoma

作　　者：谭平先[1] 雍碧城[1] 沈靖南[1] 王晋[1] 尹军强[1] 邹昌业[1] 谢显彪[1] 唐清连[1] 赵志强[1] 黄纲[1] 

机构地区：[1]中山大学附属第一医院骨肿瘤科,广州510080

出　　处：《中国骨科临床与基础研究杂志》2011年第4期256-262,共7页Chinese Orthopaedic Journal of Clinical and Basic Research

基　　金：国家自然基金资助项目(30973504);中山大学临床医学研究5010计划资助项目(1800009)

摘　　要：目的对骨肉瘤的化疗、手术及预后进行随访研究,探讨骨肉瘤治疗中影响患者预后、生存及医生治疗决策的因素。方法回顾性调查1998年1月-2008年1月单一骨肿瘤治疗中心注册的413例骨肉瘤患者的病例资料,记录患者的基本情况、手术情况、化疗情况以及随访和预后情况,比较规范化疗和未规范化疗患者局部复发、肺转移率以及生存率的差异,分析骨肉瘤治疗中存在的问题。结果 413例患者中,随访>5个月352例,失访率14.8%;随访>12个月251例,失访率39.2%;随访>60个月216例,失访率47.7%。321例行手术治疗,其中截肢手术165例,保肢手术156例。126例完成规范化疗,287例由于各种原因没有完成规范化疗或未进行化疗。不规范化疗患者肺转移发生率、5年总生存率及5年总无瘤生存率均低于规范化疗患者,差异具有统计学意义(P<0.05)。结论骨肉瘤的临床治疗存在患者就诊迟、完成规范化疗比例小、保肢率低、失访率高等问题。重视并解决这些问题对骨肉瘤患者的预后有重要意义。Objectives To investigate the factors those affect the prognosis, survival and doctors＇ decisions in the treatment of osteosarcoma through the follow-up study of the chemotherapy, surgery and prognosis. Methods Clinical data of 413 patients with osteosarcoma registered from 1998 to 2008 in a cancer center were retrospectively collected. Information about clinical conditions, surgery, chemotherapy, follow-up as well as prognosis were recorded and analyzed. The differences of recurrence, pulmonary metastasis rate and survival rate, were compared between the patients treated with standard and non-standard chemotherapy. Results Of 413 patients, 352 cases were followed-up more than 5 months, with 251 cases more than 12 months and 216 cases more than 60 months. The percentage of withdrawal at 5, 12 and 60 months were 14.8%, 39.2%, and 47.7% respectively. There were 321 patients who underwent surgery, among them, 156 cases had limb salvage surgery and 165 had amputation. In this group, 126 patients received standard chemotherapy, and 287 patients had non-standard chemotherapy or did not received chemotherapy. Patients who were treated with standard chemotherapy had a lower pulmonary metastasis and longer survival rate than that of those who were treated with non-standard chemotherapy, the difference had statistical significance （P 〈0.05）. Conclusions Late in seeking doctors, high rate of amputation, non-standard chemotherapy and the lost of follow-up, are the main obstacles that adversely affect the therapeutic effect for osteosarcoma. it is important to emphasize and solve the above problems.

关 键 词：骨肉瘤 肿瘤转移 化学疗法 辅助 外科学 预后 随访研究 

分 类 号：R738.1[医药卫生—肿瘤] R979.1[医药卫生—临床医学]