肢体骨肉瘤肺转移的诊疗进展  

Diagnosis and treatment progress for extremity osteosarcoma with lung metastasis

作　　者：闵丽梅 刘宝瑞[1] 李茹恬[1] Min Limei;Liu Baorui;Li Rutian(The Comprehensive Cancer Center,Nanjing Drum Tower Hospital,Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院肿瘤中心,南京210008

出　　处：《中华转移性肿瘤杂志》2024年第6期608-614,共7页Chinese Journal of Metastatic Cancer

摘　　要：骨肉瘤是儿童及青少年最常见的原发恶性骨肿瘤,其最常见的转移部位为肺部。新辅助、辅助化疗联合手术治疗是骨肉瘤患者的主要治疗手段,而在术前新辅助化疗、术后辅助化疗期间出现肺转移的患者一般与肿瘤耐药相关,提示预后差。肺转移的出现时间,特别是肢体骨肉瘤手术及辅助治疗期间出现肺转移时,对于做出正确临床决策提出了挑战。不仅如此,还有部分患者在手术及辅助治疗期间发现肺部可疑结节,但因为各种原因无法确诊是否为肺转移,也成为临床面临的一大难题。对于这类患者,更需要在遵循指南、进行多学科讨论的基础上,结合患者的实际情况做出正确的治疗决策。本文总结了四肢骨肉瘤出现肺转移的机制,并以骨肉瘤的诊疗指南为基础,介绍了这类情况的诊疗策略,希望能够对这类情况的临床诊疗带来帮助。Osteosarcoma,a primary malignant bone tumor in children and adolescents,frequently metastases to the lungs.Neoadjuvant/adjuvant chemotherapy in combination with surgery is the primary treatment for osteosarcoma.Osteosarcoma(especially extremity osteosarcoma)with lung metastasis during chemotherapy(preoperative/neoadjuvant or postoperative/adjuvant),however,is generally associated with tumor resistance,indicating poor prognosis.The occurrence time of lung metastasis,especially during surgery and adjuvant therapy of extremity osteosarcoma,poses a challenge to making correct clinical decisions.Moreover,suspicious lung nodules are found during surgery and adjuvant therapy in some patients and cannot be definitively diagnosed as pulmonary metastases due to various reasons,which is also a major challenge in clinical practice.For these patients,it is necessary to combine with the patient′s actual condition to make clinical decisions following the guidelines and based on multidisciplinary discussion.In this article,we summarized the mechanism of development of lung metastasis in extremity osteosarcoma,hoping to provide assistance for clinical diagnosis and treatment of such condition by introducing the corresponding diagnostic and therapeutic strategy based on the guidelines of diagnosis and treatment for osteosarcoma.

关 键 词：骨肉瘤 肺转移 肿瘤耐药 诊疗举措 

分 类 号：R73[医药卫生—肿瘤]