Bramer J A M, Abudu A A, Grimer R J, Carter S R, Tillman R M
Department of Orthopaedic Surgery G4-244, Academic Medical Center, Meibergdreef 9, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
Eur J Cancer. 2007 Sep;43(13):1944-51. doi: 10.1016/j.ejca.2007.07.004. Epub 2007 Aug 14.
The influence of pathological fracture on surgical management, local recurrence and survival was established in patients with high grade, localised, extremity osteosarcoma (n=484), chondrosarcoma (n=130) and Ewing's sarcoma (n=156). Limb salvage was possible in 79% of patients with a fracture compared to 84% of patients without a fracture (p=0.17). No difference in local recurrence was found between fracture and control groups. In univariate analysis, survival in the fracture group was lower than in the control group for osteosarcoma (34% versus 58%, p<0.01) and chondrosarcoma (35% versus 63%, p=0.04), but not for Ewing's sarcoma (75% versus 64%, p=0.80). In multivariate analysis, fracture remained a significant predictor of survival for osteosarcoma, but not for chondrosarcoma, where dedifferentiated subtype appeared to be decisive. Pathological fracture independently predicts worse survival in osteosarcoma, but not chondrosarcoma and Ewing's sarcoma. Limb saving surgery seems safe, if adequate resection margins are achieved.
在患有高级别、局限性肢体骨肉瘤（n = 484）、软骨肉瘤（n = 130）和尤因肉瘤（n = 156）的患者中，研究了病理性骨折对外科治疗、局部复发和生存的影响。发生骨折的患者中79%可行保肢手术，而未发生骨折的患者中这一比例为84%（p = 0.17）。骨折组与对照组之间未发现局部复发有差异。在单因素分析中，骨肉瘤（34%对58%，p < 0.01）和软骨肉瘤（35%对63%，p = 0.04）骨折组的生存率低于对照组，但尤因肉瘤并非如此（75%对64%，p = 0.80）。在多因素分析中，骨折仍然是骨肉瘤生存的重要预测因素，但软骨肉瘤并非如此，其中去分化亚型似乎起决定性作用。病理性骨折独立预测骨肉瘤的生存较差，但对软骨肉瘤和尤因肉瘤并非如此。如果能获得足够的切缘，保肢手术似乎是安全的。
