骨肉瘤复发患者的转归及影响长期生存的因素分析——一项基于多中心骨肉瘤复发患者的长期随访研究  

Outcome of patients with osteosarcoma after recurrence and analysis of factors affecting the long-term survival --A long-term follow-up study of recurrent patients by multicenter

作　　者：流小舟[1] 于沂阳 施鑫 周光新[1] 何志伟 张伟滨[3] 董阳 张国川[2] 吴苏稼 胡永成[5] 于秀淳 王臻 Liu Xiaozhou;Yu Yiyang;Shi Xin;Zhou Guangxin;He Zhi-wei;Zhang Weibin;Dong Yang;Zhang Guochuan;Wu Sujia;Hu Yongcheng;Yu Xiuchun;Wang Zhen(Department of Orthopedics,Jinling Hospital,Nanjing 210002,China;Department of Bone Oncolo-gy,The third hospital of hebei medical university,Shijiazhuang 050051,China;Department of Orthopedics,Ruijin hospi-tal affiliated to Shanghai fiaotong university,Shanghai 200025,China;Department of Orthopedics,The sixth people＇s hospital affiliated to Shanghai fiaotong university,Shanghai 200233,China;Department of Bone Oncology,Tianjin hospi-tal,Tianjin 300210,China;Department of Orthopedics,Jinan military general hospital,Ji＇nan 250031,China;Department of Bone Oncology,Xijing Hospital of Air Force Military Medical University,Xi＇an 710032,China)

机构地区：[1]中国人民解放军南京总医院骨科,210002 [2]河北医科大学第三医院骨肿瘤科,石家庄050051 [3]上海交通大学医学院附属瑞金医院骨科,200025 [4]上海交通大学附属第六人民医院骨科,200233 [5]天津医院骨肿瘤科,300210 [6]中国人民解放军济南总医院骨科,250031 [7]空军军医大学西京医院骨肿瘤科,710032

出　　处：《中华骨科杂志》2018年第18期1089-1096,共8页Chinese Journal of Orthopaedics

摘　　要：目的通过分析骨肉瘤复发后患者长期随访资料，探讨其转归及影响因素。方法回顾性分析2000年6月至2012年9月国内多中心收治的72例四肢骨肉瘤复发和（或）转移患者的临床资料，男37例，女35例；年龄7~61岁，平均为22．2岁。根据肿瘤复发部位分类：股骨42例（58．3％）、胫骨18例（25％）、肱骨7例（9．7％）、腓骨5例（6．9％）。根据是否合并转移分类：单纯复发14例（19．4％），复发＋转移58例（80．6％）：其中先复发29例（40．3％）、先转移9例（12．5％）、复发＋转移20例（27．8％）；14例单纯复发的患者中12例（16．7％）患者获得长期生存，2例死亡（2．8％）；58例复发＋转移的患者中6例长期存活（8．3％），52例死亡（72．2％）。应用Kaplan-Meier方法和Log-rank检验对年龄、性别、术前、术后化疗次数及复发后治疗与否分别进行单因素分析，多因素（年龄、性别、术前、术后化疗次数及复发后治疗与否）采用Cox比例风险回归模型进行生存分析。结果72例骨肉瘤复发患者10年总生存率为25％，Kaplan-Meier单因素分析结果显示，复发后继续接受治疗及术后化疗次数对复发后生存时间有显著影响，而年龄、性别以及术前化疗次数对复发后生存时间无明显影响。多因素Cox比例风险回归分析显示，复发后治疗继续与否以及术后化疗次数（〉3次）是影响总生存率的独立预测因素（P=0．002和P=0．007）。同时根据按不同指标分组的生存曲线显示，复发后术后化疗次数对TFS无显著影响；但复发后的继续治疗对提高患者的无瘤生存率、总生存率有明显的统计学意义（P=0．026和P=0．002）。结论术后规范化疗、复发病灶的扩大切除加针对性的辅助治疗对四肢骨肉瘤患者的复发后生存时间有重要影响；进一步加强多中心合作，开展骨肉瘤复发后的多模式治疗的�Objective To investigate the outcome and affecting factors of patients with osteosarcoma after recurrence. Methods Retrospective analysis was used to analyze the achieved data and prognosis-related factors of 72 patients with extremi- ty osteosarcoma after recurrence from June 2000 to September 2012 through muhicenter joint treatment. 37 males and 35 females were included. The overall age was 7 to 61 years old （average age22.2 years old）.Classification based on the tumor recurrent parts： 42 cases （58.3%） on femur, 18 cases （25%） on tibia, 7 cases （9.7%） on humerus and 5 cases （6.9%） on fibula. Classification based on metastases： 14 cases of simple recurrence （19.4%）, 58 cases （80.6%） of recurrence with metastasis： 29 cases （40.3%） of recur-rence occurred first, 9 cases （12.5%） of metastasis occurred firstly, 20 cases （27.8%） of simultaneous recurrence with metastasis; 12/14 patients （16.7%） of simple recurrence had long-term survival, but 2 died （2.8%）. Six of 58 patients （8.3%） of recurrence with metastasis had long-term survival but 52 died （72.2%）. Results The overall 10-year postrelapse survival rate of the 72 patients was 25%. Kaplan-Meier univariate analysis revealed that postrelapse survival was significantly influenced by the continued treat- ment after recurrence and the number of postoperative chemotherapy, but it was not significantly influenced by age, gender and the number of preoperative chemotherapy. Multivariate analysis revealed that the continued treatment after recurrence and the number of postoperative chemotherapy were independent prognostic factors （P=0.002, P=0.007）. At the same time, according to the smwiv- al curve grouped by different indicators, the number of chemotherapy after recurrence has no significant effect on TFS. However, the continued treatment after recurrence has obvious statistical significance on improving TFS and OS of patients （P=0.026, P= 0.002）. Conclusion Resection and standard postoperative chemoth

关 键 词：骨肉瘤 复发 预后 影响因素分析 

分 类 号：R738.1[医药卫生—肿瘤]