文章摘要
李泉,王臻,吴苏稼,张伟滨,张国川,胡永成,赵铭,姚阳,王文剑,流小舟,余文熙,程杰,于莉莉,鲍其远,韩加,于沂阳,于秀淳.40~60岁肢体骨肉瘤病人的临床治疗效果与策略.骨科,2019,10(4):261-265
40~60岁肢体骨肉瘤病人的临床治疗效果与策略
Clinical therapeutic effect and strategy of limb osteosarcoma patients aged 40-60 years
投稿时间:2019-05-13  
DOI:10.3969/j.issn.1674-8573.2019.04.002
中文关键词: 骨肉瘤  预后  化疗
英文关键词: Osteosarcoma  Prognosis  Chemotherapy
基金项目:
作者单位E-mail
李泉 山东中医药大学中医学院济南 250014中国人民解放军联勤保障部队第九六〇医院骨病科济南 250031  
王臻 空军军医大学西京医院骨肿瘤科西安 710032  
吴苏稼 中国人民解放军东部战区总医院骨科南京 210002  
张伟滨 上海交通大学医学院附属瑞金医院骨科上海 200025  
张国川 河北医科大学第三医院骨肿瘤科石家庄 050051  
胡永成 天津市天津医院骨肿瘤科天津 300211  
赵铭 河北医科大学第三医院骨肿瘤科石家庄 050051  
姚阳 上海市第六人民医院肿瘤科上海200233  
王文剑 中国人民解放军联勤保障部队第九六〇医院骨病科济南 250031  
流小舟 中国人民解放军东部战区总医院骨科南京 210002  
余文熙 上海市第六人民医院肿瘤科上海200233  
程杰 空军军医大学西京医院骨肿瘤科西安 710032  
于莉莉 中国人民解放军联勤保障部队第九六〇医院信息科济南 250031  
鲍其远 上海交通大学医学院附属瑞金医院骨科上海 200025  
韩加 中国人民解放军联勤保障部队第九六〇医院骨病科济南 250031  
于沂阳 河北医科大学第三医院骨肿瘤科石家庄 050051  
于秀淳 中国人民解放军联勤保障部队第九六〇医院骨病科济南 250031 13969132190@163.com 
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中文摘要:
      目的 分析40~60岁肢体骨肉瘤病人的临床治疗疗效,总结预后相关因素并探讨治疗策略。方法 回顾性分析2002年4月至2015年10月国内7家骨肉瘤治疗中心收治的确诊为肢体骨肉瘤的62例病人的资料,其中男34例,女28例;年龄范围限定在40~60岁,平均年龄为50.4岁;收集病人一般情况、发病部位、术前穿刺、化疗情况、手术方式、复发转移及生存情况等。以上述因素为变量指标,应用Kaplan-meier法测算生存率,研究这些因素与3年、5年生存率之间的关系。结果 62例肢体骨肉瘤病人中发病于膝关节周围者50例,约占80.6%。62例病人均得到随访,随访12~115个月,平均随访时间为43个月;3年和5年总生存率为80.6%、56.5%;3年和5年无瘤生存率为41.9%、32.3%;5年总生存率:术前化疗组与未化疗组分别为51.5%、62.1%;术后化疗组与未化疗组分别为52.1%、71.4%;术前术后均化疗组与均未化疗组为51.6%,61.3%;保肢手术组和截肢手术组分别为57.1%、53.8%。术后无复发转移、单纯复发、肺转移、多发转移的病人3年生存率分别为89.7%、78.6%、50.0%、73.3%。结论 40~60岁肢体骨肉瘤病人,膝关节周围发病率高于年轻病人,且预后较差,其预后与术前穿刺明确诊断、术后复发转移情况密切相关,其临床治疗应当建立在充分切除肿瘤的基础之上,严格遵照Enneking外科分期,降低肿瘤的复发转移率,以期改善预后。
英文摘要:
      Objective To analyze the clinical efficacy of treatment of aged 40-60 patients with osteosarcoma, summarize the prognostic factors and discuss the treatment strategy. Methods A retrospective analysis was made on 62 patients aged 40 to 60 who were diagnosed as limb osteosarcoma in 7 osteosarcoma treatment centers in China from April 2002 to October 2015. There were 34 males and 28 females. The age range was limited to 40-60 years, with an average age of 50.4 years. The data about general information, site of onset, preoperative puncture, chemotherapy, surgical methods, recurrence, metastasis and survival, and corresponding follow-up of patients were collected. Using the above factors as variables, Kaplan-meier method was used to calculate the survival rate, and the relationship between these factors and the 3- and 5-year survival rate was studied. Results The lesions occurred around the knee joint in 50 cases among 62 patients, accounting for 80.6%. All 62 patients with osteosarcoma of extremities were followed up for 12-115 months, with an average follow-up time of 43 months. The overall 3- and 5-year survival rate was 80.6% and 56.5% respectively. The 3- and 5-year disease-free survival rate was 41.9% and 32.3% respectively. The 5-year overall survival rate was 52.1% and 62.1% in preoperative chemotherapy group and non-chemotherapy group, 52.1% and 71.4% in postoperative chemotherapy group and non-chemotherapy group, 51.6% and 61.3% in preoperative and post-operative chemotherapy group and non-chemotherapy group, 57.1% and 53.8% in limb salvage operation group and amputation operation group, respectively. The 3-year survival rate postoperation in patients without recurrence or metastasis, simple recurrence, pulmonary metastasis or multiple metastasis was 89.7%, 78.6%, 50.0% and 73.3% respectively. Conclusion The incidence of osteosarcoma around knee joint is higher and the prognosis is worse in 40-60 years old patients than in younger patients. The prognosis is closely related to the definite diagnosis of preoperative puncture and the recurrence and metastasis after operation. The clinical treatment of osteosarcoma in limbs aged 40 to 60 should be based on full resection of tumors, strictly following Enneking surgical staging, and reducing the recurrence and metastasis rate of tumors in order to improve the prognosis.
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