Lee Jun Ah, Kim Min Suk, Kim Dong Ho, Lim Jung Sub, Park Kyung Duk, Song Won Seok, Lee Soo-Yong, Jeon Dae-Geun
Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Republic of Korea.
J Pediatr Hematol Oncol. 2008 Jun;30(6):419-24. doi: 10.1097/MPH.0b013e318168e7dc.
The medical records of 241 children with stage II osteosarcoma were reviewed to assess whether growth characteristics at the time of diagnosis are related to treatment outcome. We defined the maximal growth rate period as an age between 12 and 14 for girls and between 13 and 15 for boys. Accordingly, we subdivided patients into 3 groups and analyzed for clinical characteristics and metastasis-free survival (MFS). Most of the clinical characteristics showed no difference among the 3 groups. After a median follow-up of 54 months (range: 6 to 153 mo), the 5-year MFS of the entire cohort was 67.5%+/-3.1%. Patients in the period of maximal growth rate did worst (57.0%+/-5.6%, P=0.02), whereas patients before and after the period of maximal growth rate fared better (77.0%+/-5.1% and 69.4%+/-4.9%, respectively). On multivariate analysis, disease occurrence in the period of maximal growth rate [relative risk (RR) 2.44; 95% confidence interval (CI) 1.37-4.38; P=0.003], American Joint Committee on Cancer stage IIB disease (RR 2.49; 95% CI 1.49-4.17; P=0.001), and a poor histologic response (RR 2.91; 95% CI 1.78-4.77; P<0.001) independently shortened the MFS. The growth characteristics of patients that are available at the time of diagnosis carry prognostic significance and these could be used as a base to design risk-adapted therapy for osteosarcoma.
回顾了241例II期骨肉瘤患儿的病历，以评估诊断时的生长特征是否与治疗结果相关。我们将最大生长率时期定义为女孩12至14岁、男孩13至15岁之间的年龄段。据此，我们将患者分为3组，并分析其临床特征和无转移生存期（MFS）。大多数临床特征在3组之间无差异。中位随访54个月（范围：6至153个月）后，整个队列的5年MFS为67.5%±3.1%。处于最大生长率时期的患者预后最差（57.0%±5.6%，P=0.02），而在最大生长率时期之前和之后的患者预后较好（分别为77.0%±5.1%和69.4%±4.9%）。多因素分析显示，处于最大生长率时期发病[相对危险度（RR）2.44；95%置信区间（CI）1.37 - 4.38；P=0.003]、美国癌症联合委员会IIB期疾病（RR 2.49；95%CI 1.49 - 4.17；P=0.001）和组织学反应差（RR 2.91；95%CI 1.78 - 4.77；P<0.001）独立缩短了MFS。诊断时可得的患者生长特征具有预后意义，可作为设计骨肉瘤风险适应性治疗的依据。
