Bacci Gaetano, Ferrari Stefano, Longhi Alessandra, Forni Cristiana, Zavatta Marcello, Versari Michela, Smith Keith
Department of Chemotherapy, Rizzoli Orthopedic Institute, Bologna, Italy.
J Pediatr Hematol Oncol. 2002 Jan;24(1):27-30. doi: 10.1097/00043426-200201000-00008.
In osteosarcoma, as in other tumors, the presence of metastases at presentation is generally considered a consequence of late diagnosis. To verify this, the authors investigated whether there was a relationship between the stage of the disease at presentation and several clinical and pathologic characteristics, including the interval between the onset of first symptoms or signs and the final diagnosis.
One thousand seventy-one patients with high-grade osteosarcoma of the extremity were observed between 1980 and 1999. Of these, 891 had a localized tumor and 180 had metastases at the time of diagnosis.
Compared with patients with localized disease, patients with detectable metastases at the time of diagnosis had higher serum levels of alkaline phosphatase, larger primary lesions, and tumors often located in the femur and humerus. In terms of time to diagnosis, the interval between the onset of first symptoms and the final diagnosis was significantly shorter in patients with metastases than in patients with localized tumor. This surprising finding probably reflects a more rapid growth of the tumor.
These results suggest a different biologic phenotype and aggressiveness of the tumor in a subgroup of patients and that the stage of the disease at presentation depends more on the properties of these tumors than on late diagnosis.
与其他肿瘤一样，骨肉瘤患者就诊时出现转移通常被认为是诊断延迟的结果。为了验证这一点，作者调查了就诊时疾病分期与若干临床和病理特征之间是否存在关联，包括首次症状或体征出现至最终诊断的间隔时间。
1980年至1999年间观察了1071例肢体高级别骨肉瘤患者。其中，891例患者肿瘤局限，180例患者诊断时已有转移。
与肿瘤局限的患者相比，诊断时可检测到转移的患者血清碱性磷酸酶水平更高，原发肿瘤更大，且肿瘤常位于股骨和肱骨。就诊断时间而言，出现转移患者从首次症状出现到最终诊断的间隔时间显著短于肿瘤局限的患者.这一惊人发现可能反映了肿瘤生长更快。
这些结果提示，在一部分患者中肿瘤具有不同的生物学表型和侵袭性，并提示就诊时疾病分期更多地取决于这些肿瘤的特性，而非诊断延迟。
