Ozger Harzem, Eralp Levent, Atalar Ata Can, Toker Berkin, Ayan Inci, Kebudi Rejin, Bağbek Sevil, Başaran Mert, Ağaoğlu Fulya, Dizdar Yavuz, Bilgiç Bilge
Istanbul Universitesi Istanbul Tip Fakültesi, Ortopedi ve Travmatoloji Anabilim Dali.
Acta Orthop Traumatol Turc. 2007;41(3):211-9.
We evaluated long-term treatment results of patients with primary osteosarcoma and the effect of prognostic factors on overall survival and disease-free survival.
Between 1995 and 2005, 180 patients (111 males, 69 females; mean age 21+/-10 years; range 7 to 64 years) were treated for primary osteosarcoma. Overall and disease-free survival rates were analyzed for 165 patients with high-grade osteosarcoma with the Kaplan-Meier method. The effects of potential prognostic factors were assessed, including age, gender, localization, tumor size, primary metastasis on presentation, the presence of pathologic fractures, necrosis rate, and infection. All the patients received chemotherapy before and after surgery. The mean follow-up period was 49.7 months (range 6 to 185) months.
Sixty-nine patients were below 16 years of age. The most frequent involvement was in the distal femur (47.2%), followed by the proximal tibia (25%). Sixteen patients presented with a pathologic fracture, and 12 patients with metastasis. The median tumor size was 10 cm. The overall five- and 10-year survival rates were 68% and 60%, and disease-free survival rates were 50% and 44%, respectively. Only the presence of a pathologic fracture and primary metastasis on presentation were found to affect prognosis.
The two conditions, primary metastasis and a pathologic fracture, found as the most important prognostic factors in our study are mainly associated with late presentation. As in every malignant disease, early admission would provide better survival rates.
我们评估了原发性骨肉瘤患者的长期治疗结果以及预后因素对总生存期和无病生存期的影响。
1995年至2005年间，180例原发性骨肉瘤患者（男111例，女69例；平均年龄21±10岁；范围7至64岁）接受了治疗。采用Kaplan-Meier法分析了165例高级别骨肉瘤患者的总生存期和无病生存期。评估了潜在预后因素的影响，包括年龄、性别、部位、肿瘤大小、初诊时有无远处转移、病理性骨折的存在、坏死率和感染情况。所有患者在手术前后均接受化疗。平均随访期为49.7个月（范围6至185个月）。
69例患者年龄在16岁以下。最常见的受累部位是股骨远端（47.2%），其次是胫骨近端（25%）。16例患者出现病理性骨折，12例患者有转移。肿瘤中位大小为10 cm。5年和10年总生存率分别为68%和60%，无病生存率分别为50%和44%。仅发现病理性骨折的存在和初诊时的远处转移会影响预后。
在我们的研究中，发现原发性转移和病理性骨折这两个情况是最重要的预后因素，主要与就诊延迟有关。与所有恶性疾病一样，早期就诊将提供更好的生存率。
