72例骨肉瘤患者化疗效果初步评估

Abstract

目的 通过分析骨肉瘤患者临床、影像学、病理学等特点,探讨影响骨肉瘤患者预后的相关因素.方法 回顾性分析2003年6月至2007年6月就诊于北京大学人民医院骨与软组织肿瘤治疗中心的72例四肢成骨肉瘤患者的临床资料.对其进行术前化疗+手术切除+术后化疗的标准治疗方案.所有切除标本进行坏死率分析.将患者的16项临床指标,10项影像学指标与肿瘤坏死率和患者预后相比较.通过统计学方法找出相关的预后因素.结果 单因素分析:男性患者、化疗后肿瘤体积变小、肿瘤边界变清晰、骨外T2信号增强提示肿瘤坏死率高(P<0.05);多因素分析:化疗后体积变小,提示肿瘤坏死率高(P<0.05);单因素生存分析显示:化疗后碱性磷酸酶水平正常,骨外T2信号增高,肿瘤坏死率高,提示患者的生存率较高(P<0.05).多因素生存分析提示:肿瘤坏死率高的患者生存率高(P<0.05).结论 肿瘤坏死率高则患者的预后较好,通过临床、影像等多项指标综合判断,可以间接预测肿瘤坏死率,推测患者的预后.

Objective To determine the prognostic factors that influence survival of patients with non-metastatic, high-grade osteosarcoma of the extremities. Methods The data of 72 patients treated between June 2003 and June 2007, was retrospectively evaluated in relation to many factors including gender, age, etc. Results Tumor necrosis was significantly related to gender, tumor volume change, tumor margin and T2 signal intensity of the extraosseous component of bone sarcomas. Multivariate analysis, tumor necrosis was only related to tumor volume change. Upon multivariate analysis, good histologic response was related to the outcome of patients. Conclusions Event free survival is related to the tumor necrosis, the level of alkaline phosphatsse and the change of T2 signal of the extraosseous component. Tumor necrosis is related to the volume change after preoperative chemotherapy. These factors must be considered when deciding risk-adapted treatments for patients with osteosareoma.