Bacci Gaetano, Bertoni Franco, Longhi Alessandra, Ferrari Stefano, Forni Cristiana, Biagini Roberto, Bacchini Patrizia, Donati Davide, Manfrini Marco, Bernini Gabriella, Lari Stefano
Department of Musculoskeletal Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy.
Cancer. 2003 Jun 15;97(12):3068-75. doi: 10.1002/cncr.11456.
In primary central high-grade osteosarcoma, a number of distinct subtypes have been identified, but little is known about the response to chemotherapy.
The authors investigated whether the subtypes correlated with histologic response to chemotherapy in 1058 patients with osteosarcoma of the extremities who were treated with neoadjuvant chemotherapy over the last 20 years. The tumors were classified as osteoblastic (70%), chondroblastic (13%), fibroblastic (9%), and telangiectatic (6%). At diagnosis, 911 patients had localized disease and 147 had resectable lung metastases.
The response to preoperative chemotherapy was good (90% or more tumor necrosis) in 59% of patients and poor (< 90% tumor necrosis) in 41% of patients. The rate of good responses was significantly higher (P = 0.0001) in the fibroblastic (83%) and telangiectatic (80%) tumors and significantly lower in chondroblastic tumors (43%). Prognosis was significantly correlated with the histologic subtypes. The 5-year overall survival rate was significantly higher (P = 0.0001) in fibroblastic (83%) and telangiectatic (75%) tumors than in osteoblastic (62%) and chondroblastic (60%) tumors. In all subtypes, except for the chondroblastic subtype, the 5-year overall survival rate was significantly higher (P = 0.0001) in good responders P = 0.0001 (68%) than in poor responders (52%).
The authors concluded that the histologic subtype of primary central high-grade osteosarcoma of the extremity was strictly correlated with histologic response to chemotherapy and probably, as a consequence, also with prognosis. Further studies are needed to establish whether these results justify a specific therapeutic approach based on the histologic subtype of the tumor.
在原发性中央型高级别骨肉瘤中，已确定了一些不同的亚型，但对化疗反应的了解甚少。
作者调查了过去20年中接受新辅助化疗的1058例四肢骨肉瘤患者的亚型与化疗组织学反应是否相关。肿瘤分为成骨细胞型（70%）、软骨母细胞型（13%）、纤维母细胞型（9%）和毛细血管扩张型（6%）。诊断时，911例患者为局限性疾病，147例有可切除的肺转移。
59%的患者对术前化疗反应良好（肿瘤坏死率达90%或更高），41%的患者反应较差（肿瘤坏死率<90%）。纤维母细胞型（83%）和毛细血管扩张型（80%）肿瘤的良好反应率显著更高（P = 0.0001），而软骨母细胞型肿瘤的良好反应率显著更低（43%）。预后与组织学亚型显著相关。纤维母细胞型（83%）和毛细血管扩张型（75%）肿瘤的5年总生存率显著高于成骨细胞型（62%）和软骨母细胞型（60%）肿瘤（P = 0.0001）。在所有亚型中，除软骨母细胞型外，反应良好者的5年总生存率（68%）显著高于反应较差者（52%）（P = 0.0001）。
作者得出结论，四肢原发性中央型高级别骨肉瘤的组织学亚型与化疗组织学反应密切相关，可能因此也与预后相关。需要进一步研究以确定这些结果是否证明基于肿瘤组织学亚型的特定治疗方法合理。
