摘要
背景与目的：肢体骨肉瘤采取术前新辅助化疗、手术、术后辅助化疗的综合治疗模式已经被广泛接受，但是综合治疗的具体实施目前尚未达成共识。本研究通过分析81例期肢体骨肉瘤的综合治疗的临床疗效，以期为提高肢体骨肉瘤的综合治疗水平提供临床依据。方法：术前无远处转移的期肢体骨肉瘤81例，接受新辅助化疗45例，其中加用动脉灌注化疗19例，42例接受保肢治疗。化疗主要药物有甲氨蝶呤（MTX）、顺铂（DDP）、异环磷酰胺（IFO）、表柔比星（EP—ADM）。结果：全组1、2、3年生存率分别为82．4％、63．6％、32．0％，各年生存率的差异均具有显著性（P=0．010，P=0．011）。第2年远处转移率（65．9％）较第1年（40．8％）上升，且差异有显著性（P=0．008）。新辅助化疗组的中位无病生存时间为24．63个月，非新辅助化疗组为15．01个月，两组之间的差异有显著性（P=0．008）。辅助化疗〈6次的患者2年生存率最低（12．5％），化疗〉10次组患者2年生存率（76．4％）显著高于化疗6—10次组（42．1％）（P=0．049）；保肢治疗组1、2、3年局部复发率（分别为23．1％，52．6％和36．4％）均显著性高于截肢组（分别为2．7％，4．0％和0）（P=0．022，P=0．001，P=0．026），保肢和截肢治疗组1、2年生存率均无显著差异。结论：远处转移是骨肉瘤生存率低的主要原因，新辅助化疗及增加术后辅助化疗次数可能提高患者生存率。截肢可降低局部复发机会，但不能减少远处转移。
Background and purpose： The systematic treatment for patients with osteosarcoma in extremities was widely accepted including neo-adjuvant chemotherapy, operation and adjuvant chemotherapy; however, detailed rules of the stratety have not been well recognized. The current study investigated the proper combination of different treatment strategy and their efficacy. Methods： 81 patients with non-distal metastatic osteosarcoma in extremities were treated with regimens including MTX, DDP, IFO, EP-ADM. 19 cases received additional intra-arterial chemotherapy among 45 patients who received neo-adjuvant chemotherapy, and 41 cases underwent limb salvage surgery among 81 patients. Results： The 1-year, 2-year and 3-year survival rates were 82.4%, 63.6% and 32.0%, respectively. The distal metastatic rate of the second year was significantly higher than that of the first year （65.9% vs. 40.8%, P = 0. 008）. Median disease-free survival was 24.63 months in the neo-adjuvant chemotherapy group compared with 15.01 months in patients without neo-adjuvant chemotherapy group, there was significantly difference between two groups （ P = 0. 008）. The 2-year survival rate was 12.5% for the patients who received less than 6 cycles of chemotherapy, 76.4% for the patients who received over 10 cycles of chemotherapy and 42.1% for the patients with 6-10 cycles of chemotherapy, there were significant differences among the groups （ P = 0. 049）. Although there were no significant difference in 1 -year and 2-year survival rates between limb salvage group and amputation group, local recurrent rate of 1-year, 2-year and 3-year in llmb salvage group were 23.1%, 52.6% and 36.4%, respectively and significantly higher than that in amputation group （2.7%, 4.0% and 0.0%, respectively） （P = 0.022, P = 0. 001 and P = 0. 026, respectively）. Conclusions： Poor survival rate of osteosarcoma-patients which was primarily attributed to distal metastasis can be improved through application of neo-adjuvant chemotherapy and more cycles of adjuvant chemotherapy. Amputation could decrease the chances of local relapses but could not impact on metastasis.
出处
《中国癌症杂志》
CAS
CSCD
2008年第4期286-290,共5页
China Oncology
基金
上海市科委定向科研计划资助项目(No:064119637)
关键词
骨肉瘤
综合治疗
临床疗效
osteosarcoma
systematic treatment
clinical efficacy
