| 乔相帅,郑凯,徐明,等.肿瘤生长方式影像学表现对骨肉瘤预后影响的临床研究.骨科,2024,15(4): 332-338. |
| 肿瘤生长方式影像学表现对骨肉瘤预后影响的临床研究 |
| Impact of Imaging Manifestations of Tumor Growth Patterns on the Prognosis of Osteosarcoma |
| 投稿时间：2024-03-29 |
| DOI：10.3969/j.issn.1674-8573.2024.04.008 |
| 中文关键词: 骨肉瘤 四肢 磁共振成像 肿瘤大小 预后 |
| 英文关键词: Osteosarcoma Extremities Magnetic resonance imaging Tumor size Prognosis |
| 基金项目: |
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| 摘要点击次数: 818 |
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| 中文摘要: |
| 目的 探讨骨肉瘤生长方式与病人预后的相关性。方法 收集2007年1月至2018年8月于中国人民解放军联勤保障部队第九六〇医院确诊为四肢骨肉瘤的119例病人的病历资料。根据MRI图像所显示的骨肉瘤生长方式将病人分为均匀生长型、渐进生长型和纵向生长型。Fisher精确检验分析骨肉瘤生长方式与病人临床特征之间的相关性；Kaplan-Meier分析病人5年无事件生存率和5年总生存率，通过Log-rank分析其生存差异；Cox比例风险模型进行多因素分析。结果 均匀生长型44例（37.0%），渐进生长型35例（29.4%），纵向生长型40例（33.6%）。三型骨肉瘤病人比较，纵向生长型初诊转移率最高（χ2=14.615，P=0.001）；均匀生长型肿瘤体积较小，纵向生长型肿瘤体积较大，渐进生长型肿瘤体积介于两者之间（χ2=29.322，P＜0.001）；均匀生长型化疗效果优于渐进生长型和纵向生长型（χ2=6.640，P=0.035）；均匀生长型局部复发率低，渐进生长型和纵向生长型局部复发率高（χ2=8.005，P=0.023）；纵向生长型远处转移率高，渐进生长型次之，均匀生长型远处转移率低（χ2=6.708，P=0.037）；均匀生长型、渐进生长型和纵向生长型5年总生存率分别为72.7%、65.7%和50.0%（χ2=17.407，P＜0.001）；均匀生长型、渐进生长型和纵向生长型5年无事件生存率分别为63.6%、51.4%和37.5%（χ2=15.477，P＜0.001）。多因素预后分析表明肿瘤生长方式、肿瘤体积、肿瘤体积比率、Enneking分期对病人生存具有明显统计学意义，系独立预后因素（P＜0.05）。结论 骨肉瘤生长方式可以作为判断骨肉瘤预后的重要参考依据之一，均匀生长型预后较好，渐进生长型次之，纵向生长型预后较差。 |
| 英文摘要: |
| Objective To investigate the correlation between the growth pattern of osteosarcoma and the prognosis of patients. Methods The medical records of patients diagnosed with extremity osteosarcoma were collected at the 960th Hospital of the People's Liberation Army of China from January 2007 to August 2018. Patients with osteosarcoma were classified into 3 types based on the growth patterns revealed by MRI images: homogeneous growth type, progressive growth type, and longitudinal growth type. Fisher's exact test was used to analyze the correlation between the growth patterns of osteosarcoma and the clinical characteristics of patients. The 5-year event-free survival rate and the 5-year overall survival rate of the patients were analyzed using the Kaplan-Meier method, and their survival differences were assessed by Log-rank analysis. The Cox proportional hazards model was employed for multivariate analysis. Results There were 44 cases (37%) of homogeneous growth type, 35 cases (30%) of progressive growth type, and 40 cases (33%) of longitudinal growth type. Among the three types of osteosarcoma patients, those with the longitudinal growth type had the highest rate of metastasis at the time of initial diagnosis (χ2=14.615, P=0.001); Tumors of the homogeneous growth type were relatively small in volume, while those of the longitudinal growth type were larger. Tumors of the progressive growth type had volumes that fell between the two (χ2=29.322, P＜0.001). The chemotherapy efficacy was superior for tumors of the homogeneous growth type to those of the progressive and longitudinal growth types (χ2=6.640, P=0.035). The local recurrence rate was low for tumors of the homogeneous growth type, while it was higher for tumors of the progressive and longitudinal growth types (χ2=8.005, P=0.023). The rate of distant metastasis was high for tumors of the longitudinal growth type, followed by the progressive growth type, while it was lowest for tumors of the homogeneous growth type (χ2=6.708, P=0.037); The 5-year overall survival rates for the homogeneous growth type, progressive growth type, and longitudinal growth type were 72.7%, 65.7%, and 50.0%, respectively (χ2=17.407, P＜0.001). The 5-year event-free survival rates for the uniform growth type, progressive growth type, and longitudinal growth type were 63.6%, 51.4%, and 37.5%, respectively (χ2=15.477, P＜0.001). The multifactorial prognostic analysis indicated that the tumor growth pattern, tumor volume, tumor volume ratio, and Enneking staging were significantly correlated with patient survival and were independent prognostic factors (P＜0.05). Conclusion The growth pattern of osteosarcoma can serve as one of the important references for predicting the prognosis of osteosarcoma, with the homogeneous growth type having a better prognosis, followed by the progressive growth type, and the longitudinal growth type having a poorest prognosis. |
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