Department of Surgery, McMaster University, Hamilton, ON, Canada.
Ann Surg Oncol. 2011 Jun;18(6):1705-9. doi: 10.1245/s10434-010-1532-z. Epub 2011 Jan 22.
The surgical management of grade I intramedullary chondrosarcoma of bone remains controversial. The purpose of this study was to perform a systematic review and meta-analysis of published data to determine the oncologic outcomes of intralesional versus wide resection for grade I intramedullary chondrosarcoma.
Literature searches were performed through Medline, EMBASE, and the Cochrane Database. Cohort studies in which one patient group with grade I chondrosarcoma underwent wide resection and one underwent intralesional curettage were included. Two reviewers independently assessed all eligible papers with the Newcastle-Ottawa Quality Assessment Scale for Cohort Studies. The outcome measures were the pooled odds ratio and 95% confidence intervals for the risk of local recurrence and metastasis calculated through the random-effects method.
Five eligible studies were identified including a total of 190 patients, 78 of whom underwent intralesional resection and 112 of whom underwent wide resection. Only one pelvic lesion was identified, which underwent wide resection. There were a total of five local recurrences and three metastases. The risk for local recurrence and metastasis did not differ significantly between the two groups, with an odds ratio for intralesional resection of 2.26 (95% confidence interval, 0.41-12.62) and 0.44 (95% confidence interval, 0.04-5.21) respectively.
Intralesional curettage as an alternative to wide resection for extrapelvic grade I chondrosarcoma of bone does not greatly increase the risk for local recurrence or metastasis. Overall effect estimates, however, should be interpreted with caution as a result of the relatively small number of events.
骨内 I 级软骨肉瘤的手术治疗仍存在争议。本研究旨在对已发表数据进行系统回顾和荟萃分析，以确定 I 级髓内软骨肉瘤的腔内切除与广泛切除的肿瘤学结果。
通过 Medline、EMBASE 和 Cochrane 数据库进行文献检索。纳入的队列研究中，一组患者行广泛切除，另一组患者行腔内刮除。两名审查员使用纽卡斯尔-渥太华质量评估量表（Newcastle-Ottawa Quality Assessment Scale for Cohort Studies）独立评估所有合格论文。通过随机效应法计算局部复发和转移的风险的合并优势比（odds ratio）和 95%置信区间（confidence interval）。
确定了 5 项合格研究，共纳入 190 名患者，其中 78 名患者行腔内切除术，112 名患者行广泛切除术。仅发现 1 例骨盆病变，行广泛切除术。共有 5 例局部复发和 3 例转移。两组之间局部复发和转移的风险无显著差异，腔内切除术的优势比为 2.26（95%置信区间，0.41-12.62）和 0.44（95%置信区间，0.04-5.21）。
对于骨外 I 级软骨肉瘤，腔内刮除术替代广泛切除术并不会显著增加局部复发或转移的风险。然而，由于事件数量相对较少，总体效果估计应谨慎解释。
