Ferguson Peter C, McLaughlin Catherine E, Griffin Anthony M, Bell Robert S, Deheshi Benjamin M, Wunder Jay S
Division of Orthopaedic Surgery, Mount Sinai Hospital, Department of Surgery, University Musculoskeletal Oncology Unit, University of Toronto, Toronto, Ontario, Canada.
J Surg Oncol. 2010 Aug 1;102(2):120-4. doi: 10.1002/jso.21542.
There have been variable reports of outcomes of patients with osteosarcoma and pathologic fractures. The purpose of this study was to document outcomes after management of this clinical entity at a single large oncology center.
A retrospective review was undertaken of our database between 1989 and 2006. We compared oncologic and functional outcomes of 201 patients with high-grade osteosarcoma without pathologic fractures to 31 patients with pathologic fractures.
The rate of amputation in the group with pathologic fracture was significantly higher than the group without fracture (39% vs. 14%, P = 0.001). There was no difference in the rate of local recurrence between groups. The 5-year survival was superior in the group without pathologic fracture (60% vs. 41%, P = 0.0015). For patients with localized disease, 5-year survival was higher in patients without fracture (68% vs. 52%, P = 0.006). Disability as measured by the Toronto Extremity Salvage Score was no different between the groups. Impairment as measured by the Musculoskeletal Tumor Society scores was lower in the group without fracture.
Presentation with a pathologic fracture in osteosarcoma did not preclude limb salvage surgery in a majority of patients, did not increase the risk of local recurrence, but was associated with poorer overall survival.
骨肉瘤合并病理性骨折患者的预后报道不一。本研究旨在记录在一家大型肿瘤中心对这一临床实体进行治疗后的预后情况。
对1989年至2006年我们数据库中的资料进行回顾性分析。我们将201例无病理性骨折的高级别骨肉瘤患者与31例有病理性骨折的患者的肿瘤学和功能预后进行了比较。
病理性骨折组的截肢率显著高于无骨折组（39%对14%，P = 0.001）。两组间局部复发率无差异。无病理性骨折组的5年生存率更高（60%对41%，P = 0.0015）。对于局限性疾病患者，无骨折患者的5年生存率更高（68%对52%，P = 0.006）。用多伦多肢体挽救评分衡量的残疾程度在两组间无差异。用肌肉骨骼肿瘤学会评分衡量的功能障碍在无骨折组更低。
骨肉瘤合并病理性骨折在大多数患者中并不排除保肢手术，不增加局部复发风险，但与总体生存率较低相关。
