论文部分内容阅读
目的探讨Ⅲ期骨肉瘤的诊断、治疗和预后。方法分析1989年12月至2003年12月收治的23例Ⅲ期肢体骨肉瘤患者,男14例,女9例;年龄16～31岁,平均22.4岁。肺转移15例,骨转移7例(跳跃转移5例,骨肉瘤病2例),同时存在肺和骨转移1例。经术前化疗,并行原发肿瘤和转移病灶的切除手术。结果经术前化疗,1例就诊时肺部有1个结节的患者转移瘤消失,1例同时存在肺和骨转移者,切除原发病灶后,出现多处转移,不能行转移灶切除手术;2例骨肉瘤病者仅切除原发病灶;5例跳跃转移者中的2例,切除原发和跳跃转移病灶后,各出现1个肺转移灶。16例行开胸术,其中6例再次出现肺转移灶而行二次开胸术,3例患者二次开胸术后出现肺外转移而放弃治疗。原发病灶与转移病灶的肿瘤坏死率差异无统计学意义。随访5～168个月(平均74.6个月),无瘤生存9例,带瘤生存4例,死亡10例。Cox模型分析提示转移病灶的数目与预后相关(P<0.05)。肺转移与跳跃转移病灶的Kaplan-Meier生存曲线经log-rank检验,差异无统计学意义。结论新辅助化疗及原发病灶和转移灶的手术切除是Ⅲ期骨肉瘤治疗的有效方法,首次肺转移灶切除采用胸骨正中切口,转移瘤的数目与预后相关。
Objective To investigate the diagnosis, treatment and prognosis of stage Ⅲ osteosarcoma. Methods From December 1989 to December 2003, 23 patients with stage Ⅲ osteosarcoma were analyzed. There were 14 males and 9 females, aged from 16 to 31 years, with an average of 22.4 years. There were 15 cases of lung metastasis, 7 cases of bone metastasis (5 cases of skip metastasis and 2 cases of osteosarcoma), and 1 case of lung and bone metastasis. The preoperative chemotherapy, parallel primary tumor and metastatic lesions resection. Results In the preoperative chemotherapy, one patient had one nodule in the lung and metastasis disappeared in one patient. One patient had lung and bone metastasis at the same time. After removal of the primary lesion, multiple metastases occurred and the metastases were not removed ; 2 cases of osteosarcoma patients only excision of the primary lesion; 5 cases of jumping metastases in 2 cases, removal of primary and skip metastatic lesions, the emergence of a lung metastases. Thirteen patients underwent open thoracotomy. Six patients underwent second thoracotomy again with pulmonary metastases, and three patients underwent extrapulmonary metastases after second thoracotomy. There was no significant difference in tumor necrosis rate between primary lesion and metastatic lesion. The patients were followed up for 5 to 168 months (mean, 74.6 months). There were 9 patients without tumor, 4 patients with tumor and 10 patients died. Cox model analysis suggested that the number of metastatic lesions correlated with the prognosis (P <0.05). Kaplan-Meier survival curves of lung metastasis and skip metastasis were not significantly different by log-rank test. Conclusions Neoadjuvant chemotherapy and surgical resection of primary and metastatic tumors are effective methods for the treatment of stage Ⅲ osteosarcoma. The first median lung sternal resection of the sternum is performed. The number of metastases is related to the prognosis.