Department of Orthopedic Surgery, Korea Cancer Center Hospital, Seoul, Korea.
Ann Surg Oncol. 2011 Jun;18(6):1710-6. doi: 10.1245/s10434-010-1536-8. Epub 2011 Jan 11.
Known risk factors (surgical margin, tumor necrosis) of local recurrence (LR) in osteosarcoma are determined by results available after surgery. However, relations between preoperative characteristics and LR have not been clearly defined.
We compared the clinicopathologic characteristics of 36 osteosarcoma patients with LR and 394 patients without LR after surgery. In addition, prognostic variables were evaluated to establish factors could influence LR.
Compared to the non-LR group, the LR group showed an increase in tumor volume ratio (TVR) during preoperative chemotherapy (P < 0.01), inadequate surgical margin (P < 0.01), and poor histologic response (P < 0.01). Univariate analysis of data from 430 patients revealed that an increased TVR (P < 0.01), inadequate surgical margin (P < 0.01), poor histologic response (P < 0.01), and nonosteoblastic pathologic subtype (P = 0.04) were negatively related to LR-free survival. In multivariate analysis, an elevated TVR (P < 0.01, relative risk = 10.26) and inadequate surgical margin (P < 0.01, relative risk = 5.91) emerged as the key prognostic factors for LR.
A TVR increase during preoperative chemotherapy could be used to predict patients at high risk of LR. This finding might be useful when considering surgical options to decrease the risk of LR.
骨肉瘤局部复发（LR）的已知危险因素（手术切缘、肿瘤坏死）是由手术后的结果确定的。然而，术前特征与 LR 之间的关系尚未明确界定。
我们比较了 36 例 LR 患者和 394 例术后无 LR 患者的临床病理特征。此外，评估了预后变量，以确定可能影响 LR 的因素。
与非 LR 组相比，LR 组在术前化疗期间肿瘤体积比（TVR）增加（P < 0.01），手术切缘不足（P < 0.01），组织学反应不良（P < 0.01）。对 430 例患者的数据进行单因素分析显示，TVR 增加（P < 0.01）、手术切缘不足（P < 0.01）、组织学反应不良（P < 0.01）和非成骨病理亚型（P = 0.04）与无 LR 生存呈负相关。多因素分析显示，升高的 TVR（P < 0.01，相对风险= 10.26）和手术切缘不足（P < 0.01，相对风险= 5.91）是 LR 的关键预后因素。
术前化疗期间 TVR 的增加可用于预测 LR 风险较高的患者。当考虑降低 LR 风险的手术选择时，这一发现可能很有用。
