Huang Yu-Min, Hou Chun-Han, Hou Sheng-Mou, Yang Rong-Sen
Departments of Orthopaedics, College of Medicine, National Taiwan University and Hospital, Taipei, Taiwan.
Clin Med Oncol. 2009 Sep 14;3:99-105. doi: 10.4137/cmo.s531.
The author intended to clarify the therapeutic effect and prognostic factors of metastasectomy and timing of pulmonary metastases in osteosarcoma patents.
Data was obtained retrospectively on all consecutive osteosarcoma patients from 1985 to 2005 in author's institute. Fifty-two patients with pulmonary nodules were identified, including 24 patients undergoing pulmonary metastasectomy treatment. These patients were categorized into four groups: group 1, patients with lung metastases at the initial presentation; group 2, lung metastases identified during the period of pre-operative chemotherapy; group 3, lung metastases identified during period of the post-operative che motherapy; group 4, lung metastases identified after therapy for the primary osteosarcoma completed.
In our study, the 2-, 3-, and 5-year overall survival rates for 52 patients were 49%, 39% and 20%. The 2-year overall survival rates were 18% for group 1, 32% for group 3, and 70% for group 4 (p < 0.001). The 5-year overall survival rate was 34% for group 4. Patients who underwent metastesectomy showed a better survival outcome as compared with the patients not undergoing metastasectomy (p = 0.003). The 2-year and 5-year overall survival rates of only one lung metastatic nodule were 62% and 50%, and for initially multiple lung metastatic nodules, 45% and 5%, respectively. In addition, the patients presented with lung metastases had a worse prognosis as compared with those without initial lung metastases (p = 0.0001).
The patients having single metastatic nodule showed a better prognosis than those with multiple lung nodules. Furthermore, those patients who underwent metastasectomy survived longer than those not undergoing metastasectomy. Patients who had late metastases after complete chemotherapy had a better prognosis; whereas those who had metastases identified at the initial presentation predicted a poor prognosis.
作者旨在阐明骨肉瘤患者肺转移瘤切除术的治疗效果、预后因素以及肺转移的时机。
回顾性收集了作者所在机构1985年至2005年所有连续的骨肉瘤患者的数据。确定了52例有肺结节的患者，其中24例接受了肺转移瘤切除术治疗。这些患者被分为四组：第1组，初诊时即有肺转移的患者；第2组，术前化疗期间发现的肺转移患者；第3组，术后化疗期间发现的肺转移患者；第4组，原发性骨肉瘤治疗完成后发现的肺转移患者。
在我们的研究中，52例患者的2年、3年和5年总生存率分别为49%、39%和20%。第1组的2年总生存率为18%，第3组为32%，第4组为70%（p<0.001）。第4组的5年总生存率为34%。与未接受转移瘤切除术的患者相比，接受转移瘤切除术的患者生存结局更好（p=0.003）。仅一个肺转移结节患者的2年和5年总生存率分别为62%和50%，而最初有多个肺转移结节患者的2年和5年总生存率分别为45%和5%。此外，有肺转移的患者与无初始肺转移的患者相比，预后更差（p=0.0001）。
单个转移结节的患者比多个肺结节的患者预后更好。此外，接受转移瘤切除术的患者比未接受转移瘤切除术的患者存活时间更长。完全化疗后出现晚期转移的患者预后较好；而初诊时即有转移的患者预后较差。
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