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目的探讨儿童和青少年骨肉瘤患者预后影响因素.方法回顾性分析1990年1月至2006年1月云南省第二人民医院肿瘤科收治的初发骨肉瘤患儿32例,采用COSS 96方案治疗.分析5 a生存率(overallsurvival,OS)和5 a无病生存率(event-free survival,EFS)与诊断时是否转移、接受手术类型、肿瘤位置、性别、组织学类型、对术前化疗组织反应以及患病年龄之间的关系.结果所有患者5 a OS为59.4%(19/32),EFS为46.9%(15/32).无转移患者5 a OS显著高于有转移的患者(P<0.05),晚期转移患者5 a OS显著高于早期转移患者(P<0.05).保肢术或截肢术的术后复发率无显著性差异(P>0.05),5 a OS及5 a EFS之间无显著性差异(P>0.05).肿瘤原发部位在肢体近端或远端及不同组织学类型之间5 a OS、EFS无显著差异(P>0.05),新辅化疗敏感的患者5 a OS及5 a EFS均高于新辅化疗不敏感的患者(P<0.05).男、女性骨肉瘤患者5 a OS和EFS之间无显著性差异(P>0.05),年龄≤14岁患者5 a OS 75%(12/16)、EFS 68.8%(11/16),高于年龄>14岁的患者OS 43.8%(7/16)、EFS26.7%(4/16),P<0.05.结论多数患者可通过强化化疗和外科手术取得较好治疗效果.保肢手术不显著增加不良预后,但却能提供较好的的生存质量;伴有远处转移和局部复发的患者预后较差.对化疗组织反应好、年龄<14岁的患者预后较好.
Objective To investigate the influencing factors of prognosis of osteosarcoma in children and adolescents.Methods 32 patients with primary osteosarcoma admitted from Department of Oncology, Second People’s Hospital of Yunnan Province from January 1990 to January 2006 were retrospectively analyzed and treated with COSS 96 regimen. The 5-year survival rate (OS) and 5-year survival-free survival (EFS) were compared with those of patients with metastasis at diagnosis. The type of operation, tumor location, sex and histological type were analyzed. And the age of illness were analyzed.Results The 5-year OS was 59.4% (19/32) and the EFS was 46.9% (15/32) in all patients.The 5-year OS was significantly higher in patients without metastasis than those with metastasis (P < 0.05). The 5-year OS was significantly higher in patients with advanced metastasis than that in patients with early metastasis (P <0.05). There was no significant difference in the recurrence rate between limb salvage and amputation (P> 0.05) There was no significant difference between the two groups (P> 0.05). There was no significant difference in 5 a OS and EFS between the proximal and distal limbs and between different histological types (P> 0.05) a OS and 5-year EFS were significantly higher than those in patients who were not sensitive to neoadjuvant chemotherapy (P <0.05). There was no significant difference between 5-year OS and EFS in male and female patients with osteosarcoma (P> 0.05). The mean age at 14 years was 75% (12/16) in 5 a OS and 68.8% (11/16) in EFS, which was 43.8% (7/16) higher than that in patients> 14 years old. 7% (4/16), P <0.05.Conclusion The majority of patients can obtain better therapeutic effect through intensive chemotherapy and surgery.The limb salvage surgery does not significantly increase the adverse prognosis, but it can provide better quality of life; with Patients with distant metastasis and local recurrence have a poorer prognosis, and patients who respond well to chemotherapy have a better prognosis for patients <14 years of age.