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目的 :系统评价合并病理性骨折对肢体骨肉瘤患者预后的影响。方法 :检索EMBASE、Cochrane Library、Pub Med、中国知网、万方数据库、维普数据库和中国生物医学文献数据库。纳入比较肢体骨肉瘤合并病理性骨折与未合并病理性骨折患者临床疗效的相关文献,应用NewcastleOttawa量表评价文献质量,并提取资料。应用Stata 12.0软件进行Meta分析。结果 :共10项研究符合纳入标准,总样本量为2 604例,其中合并病理性骨折356例(研究组),未合并病理性骨折2 248例(对照组)。Meta分析结果显示,研究组患者的3年总生存率[比值比为2.57,95%可信区间(coni dence interval,CI):1.54~4.29;P=0.000]和5年总生存率(比值比为1.57,95%CI:1.05~2.34;P=0.029)均低于对照组患者。研究组患者的3年无事件生存率(比值比为1.87,95%CI:1.21~2.87;P=0.005)和5年无事件生存率(比值比为1.52,95%CI:1.16~1.99;P=0.002)也均低于对照组患者。两组患者的局部复发风险差异无统计学意义(P>0.05)。在合并病理性骨折组中,截肢术与保肢术的局部复发风险差异也无统计学意义(P>0.05)。结论 :肢体骨肉瘤合并病理性骨折患者的预后较未合并病理性骨折患者的差。保肢术并未明显增加合并病理性骨折的肢体骨肉瘤患者的局部复发风险。
Objective: To systematically evaluate the prognosis of patients with osteosarcoma complicated with pathological fracture. Methods: The EMBASE, Cochrane Library, Pub Med, CNKI, Wanfang Database, VIP Database and China Biomedical Literature Database were searched. To compare the clinical efficacy of limb osteosarcoma patients with pathologic fracture and non-pathological fracture, the Newcastle Ottawa scale was used to evaluate the quality of the literature and to extract the data. Meta-analysis was performed using Stata 12.0 software. Results: A total of 10 studies met the inclusion criteria. The total sample size was 2 604, including 356 cases with pathologic fracture (research group) and 2 248 cases without pathological fracture (control group). Meta-analysis showed that the 3-year overall survival in the study group (odds ratio 2.57, 95% confidence interval (CI): 1.54 to 4.29; P = 0.000) and 5-year overall survival (odds ratio 1.57, 95% CI: 1.05 to 2.34; P = 0.029) were lower than those in the control group. The 3-year event-free survival rates (odds ratio 1.87, 95% CI: 1.21-2.87; P = 0.005) and 5-year event-free survival in the study group (odds ratio 1.52, 95% CI 1.16-1.99; P = 0.002) were also lower than the control group patients. There was no significant difference in the risk of local recurrence between the two groups (P> 0.05). There was also no significant difference in the risk of local recurrence between amputation and limb salvage in the group of pathological fracture (P> 0.05). Conclusion: The prognosis of limb osteosarcoma with pathologic fracture is worse than that without pathological fracture. Limb salvage did not significantly increase the risk of local recurrence in patients with osteosarcoma who had pathologic fractures.