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目的:比较合并病理性骨折与未合并病理性骨折肢体骨肉瘤患者的临床特征,并探讨影响预后的相关因素。方法:回顾性分析2003年10月—2011年10月确诊为肢体骨肉瘤的244例患者的病历资料,根据是否合并病理性骨折分为合并病理性骨折与未合并病理性骨折两组,比较这两组患者临床特征的差异。应用Kaplan-Meier法进行生存分析,应用log-rank检验进行病理性骨折组预后的单因素分析,应用COX比例风险回归模型进行预后的多因素分析。结果:与未合并病理性骨折相比,合并病理性骨折的肢体骨肉瘤患者的肿瘤体积较大(P=0.012),上肢骨肉瘤(P=0.004)以及接受截肢手术的患者所占比例较高(P=0.032),且易出现局部复发(P=0.002)。病理性骨折组的中位生存时间为16个月,未合并病理性骨折组的中位生存时间为21个月(P=0.006)。单因素分析显示,肿瘤大小、Enneking外科分期、Karnofsky体能状况评分、术后辅助化疗次数、局部复发和远处转移是影响病理性骨折患者预后的相关因素(P<0.05)。多因素分析显示,Karnofsky体能状况评分、术后辅助化疗次数和远处转移是影响预后的独立相关因素。结论:合并病理性骨折的肢体骨肉瘤患者与未合并病理性骨折的患者相比,肿瘤体积较大,上肢骨肉瘤以及接受截肢手术的比例较高,易出现局部复发,且预后较差。KPS评分、术后辅助化疗次数和远处转移是影响合并病理性骨折的肢体骨肉瘤患者预后的独立因素。
Objective: To compare the clinical features of patients with osteosarcoma without histopathology and pathological fractures, and to explore the related factors that affect the prognosis. Methods: The clinical data of 244 patients diagnosed as limb osteosarcoma from October 2003 to October 2011 were retrospectively analyzed. According to whether there were pathological fractures or not, the patients were divided into two groups: pathological fracture and non-pathological fracture Differences in clinical characteristics between the two groups. Survival analysis was performed by Kaplan-Meier method, single factor analysis of prognosis of pathological fracture group was performed by log-rank test, and multivariate analysis of prognosis was performed by COX proportional hazards regression model. Results: Patients with limb osteosarcoma with pathologic fracture had a larger tumor volume (P = 0.012), higher osteosarcoma (P = 0.004), and higher proportion of patients undergoing amputation compared with uncomplicated pathologic fractures (P = 0.032), and prone to local recurrence (P = 0.002). The median survival time in the pathologic fracture group was 16 months, and the median survival time in the non-pathologic fracture group was 21 months (P = 0.006). Univariate analysis showed that tumor size, Enneking surgical staging, Karnofsky physical status score, number of postoperative adjuvant chemotherapy, local recurrence and distant metastasis were the related factors that affected the prognosis of pathological fracture patients (P <0.05). Multivariate analysis showed that Karnofsky scores of physical status, number of postoperative adjuvant chemotherapy and distant metastasis were independently related to prognosis. Conclusion: Compared with patients without histopathological fracture, the patients with pathologic fracture of limb osteosarcoma have higher tumor volume, higher proportion of osteosarcoma of the upper extremity and amputation surgery, prone to local recurrence and poor prognosis. KPS score, the number of postoperative adjuvant chemotherapy and distant metastasis were independent prognostic factors of limb osteosarcoma patients with pathological fracture.