Pring M E, Weber K L, Unni K K, Sim F H
Department of Orthopedic Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 5905, USA.
J Bone Joint Surg Am. 2001 Nov;83(11):1630-42.
Treatment of pelvic chondrosarcoma is a difficult problem for the musculoskeletal oncologist. Poor rates of survival and high rates of local recurrence after surgical treatment have been reported in previous studies. The present study was designed to review the long-term oncologic and functional outcomes of surgical management in a large series of patients with pelvic chondrosarcoma who were treated at a single institution.
The cases of sixty-four patients with localized pelvic chondrosarcoma that had been surgically treated between 1975 and 1996 were reviewed retrospectively. The study was limited to patients who had received no previous treatment for chondrosarcoma. There were forty-one male and twenty-three female patients who had a mean age of forty-seven years (range, fifteen to eighty-eight years). The patients were followed for a minimum of three years or until death. The median duration of follow-up of the living patients was 140 months (range, thirty-nine to 295 months).
Thirty-three of the sixty-four patients were first seen with grade-1 chondrosarcoma; twenty-three, with grade-2; one, with grade-3; and seven, with grade-4 (dedifferentiated chondrosarcoma). Thirteen patients had a hemipelvectomy to achieve local tumor control, whereas fifty-one patients underwent a limb-salvage procedure. Twelve patients (19%) had local recurrence, and eleven (17%) had distant metastases. At the time of the final follow-up, forty-four patients (69%) were alive without evidence of disease, thirteen (20%) had died of the disease, six (9%) had died of unrelated causes, and one (2%) was alive with disease. Less than a wide surgical margin correlated with local recurrence (p = 0.014). High-grade tumors correlated with poor overall survival (p < 0.001). All patients who had a limb-salvage procedure were able to walk at the time of the final follow-up, and they had a mean functional score of 77%, according to the system of the Musculoskeletal Tumor Society.
Aggressive surgical resection of pelvic chondrosarcoma results in long-term survival of the majority of patients. There is a high correlation between tumor grade and overall or disease-free survival.
对于肌肉骨骼肿瘤学家而言，骨盆软骨肉瘤的治疗是一个难题。既往研究报告了手术治疗后生存率低和局部复发率高的情况。本研究旨在回顾在单一机构接受治疗的大量骨盆软骨肉瘤患者手术治疗的长期肿瘤学和功能结局。
回顾性分析了1975年至1996年间接受手术治疗的64例局限性骨盆软骨肉瘤患者的病例。该研究仅限于未曾接受过软骨肉瘤治疗的患者。有41例男性和23例女性患者，平均年龄47岁（范围15至88岁）。患者至少随访3年或直至死亡。存活患者的中位随访时间为140个月（范围39至295个月）。
64例患者中，33例初诊为1级软骨肉瘤；23例为2级；1例为3级；7例为4级（去分化软骨肉瘤）。13例患者接受了半骨盆切除术以实现局部肿瘤控制，而51例患者接受了保肢手术。12例患者（19%）出现局部复发，11例（17%）出现远处转移。在最后随访时，44例患者（69%）存活且无疾病证据，13例（20%）死于该疾病，6例（9%）死于无关原因，1例（2%）带瘤存活。手术切缘不足与局部复发相关（p = 0.014）。高级别肿瘤与总体生存率低相关（p < 0.001）。所有接受保肢手术的患者在最后随访时均能行走，根据肌肉骨骼肿瘤学会的系统，他们的平均功能评分为77%。
积极手术切除骨盆软骨肉瘤可使大多数患者长期存活。肿瘤分级与总体生存率或无病生存率之间存在高度相关性。
