Hamre Merlin R, Severson Richard K, Chuba Paul, Lucas David R, Thomas Ron L, Mott Michael P
Department of Pediatrics, Wayne State University, Detroit, MI, USA.
Radiother Oncol. 2002 Dec;65(3):153-7. doi: 10.1016/s0167-8140(02)00150-0.
The aim of this study is to compare primary and secondary osteosarcomas using data from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program.
Osteosarcoma cases were identified in the SEER Cancer Incidence Public-Use Database, 1973-96 (1,511 primary and 133 secondary osteosarcomas). Secondary osteosarcomas were further classified as occurring within or outside the previously irradiated field. Comparisons among groups were performed by nominal logistic regression. Survival analyses were performed using Kaplan-Meir and proportional hazards regression.
Secondary osteosarcomas were more likely to have a non-extremity primary site and an older age at diagnosis (>40 years) (<0.0001 for both). Secondary osteosarcoma cases continued to be more likely to have a non-extremity site when excluding those occurring within the radiation field. Five-year overall survival was 50% lower for secondary osteosarcomas for both extremity and non-extremity sites. Primary malignancies associated with secondary osteosarcomas included 14 lymphomas/leukemias, six sarcomas, 54 carcinomas, and seven other cancers. Secondary osteosarcomas occurring within a field of radiation were more likely to occur at a younger age, have a malignancy with a primary morphology other than carcinoma, a non-limb site, and a longer duration between their primary malignant neoplasms and the development of osteosarcoma. No difference in the overall survival was noted between secondary osteosarcomas occurring within an irradiated field and those that did not.
Secondary osteosarcomas are associated with carcinomas especially in the elderly. Although a 50% decreased 5-year survival was observed for secondary osteosarcomas in this study, this might not reflect the current outcomes with more aggressive therapy.
本研究旨在利用美国国立癌症研究所的监测、流行病学和最终结果（SEER）计划的数据，比较原发性和继发性骨肉瘤。
在SEER癌症发病率公共使用数据库（1973 - 1996年）中识别骨肉瘤病例（1511例原发性骨肉瘤和133例继发性骨肉瘤）。继发性骨肉瘤进一步分为发生在先前放疗区域内或外。通过名义逻辑回归进行组间比较。使用Kaplan-Meir和比例风险回归进行生存分析。
继发性骨肉瘤更有可能发生在非四肢的原发部位，且诊断时年龄较大（>40岁）（两者均<0.0001）。排除发生在放疗区域内的病例后，继发性骨肉瘤病例仍更有可能发生在非四肢部位。四肢和非四肢部位的继发性骨肉瘤的五年总生存率均降低了50%。与继发性骨肉瘤相关的原发性恶性肿瘤包括14例淋巴瘤/白血病、6例肉瘤、54例癌和7例其他癌症。发生在放疗区域内的继发性骨肉瘤更有可能在较年轻时发生，原发性形态为非癌性恶性肿瘤，发生在非肢体部位，且原发性恶性肿瘤与骨肉瘤发生之间的间隔时间更长。发生在放疗区域内的继发性骨肉瘤与未发生在放疗区域内的继发性骨肉瘤在总生存率上没有差异。
继发性骨肉瘤尤其与老年人的癌相关。尽管本研究中观察到继发性骨肉瘤的五年生存率降低了50%，但这可能无法反映当前更积极治疗的结果。
