Royal Liverpool and Broadgreen University Hospitals NHS Trust, Orthopaedics, Prescott Street, Liverpool, United Kingdom.
Eur J Surg Oncol. 2011 Jun;37(6):532-6. doi: 10.1016/j.ejso.2011.02.007. Epub 2011 Mar 4.
Pathologic fractures of the proximal femur resulting from primary bone sarcomas are often difficult to treat and some are often not recognized resulting in inappropriate interventions prior to the correct diagnosis being made. The aim of the study was to identify factors determining the survival after pathologic fractures of the proximal femur resulting from nonosteogenic primary bone sarcomas.
We retrospectively reviewed 72 patients with nonosteogenic primary bone sarcomas of the proximal femur (chondrosarcoma in 34 patients, spindle cell sarcoma in 25 and Ewing's sarcoma in 13). There were 40 male and 32 female patients. The mean age was 49 years. We analyzed patient, tumor, and treatment factors in relation to overall survival. The mean follow up was 55 months (range 0-302 months).
The overall 5-year survival rate was 44% (Ewing's sarcoma 60%, chondrosarcoma 57%, spindle cell sarcoma 30%, and dedifferentiated chondrosarcoma 0%). The diagnosis of spindle cell sarcoma and dedifferentiated chondrosarcoma was the only significant factor adversely affecting survival. There was no difference in survival resulting from timing of the fracture, site of the fracture, age at diagnosis, surgical margin, limb salvage or amputation.
The key-factor adversely affecting the survival after pathologic fractures of the proximal femur resulting from nonosteogenic primary bone sarcomas is the histological diagnosis of dedifferentiated chondrosarcoma and spindle cell sarcoma.
由原发性骨肉瘤引起的股骨近端病理性骨折通常难以治疗，有些骨折常常无法识别，导致在做出正确诊断之前进行了不当的干预。本研究的目的是确定导致非成骨性原发性骨肉瘤引起的股骨近端病理性骨折后生存的因素。
我们回顾性分析了 72 例股骨近端非成骨性原发性骨肉瘤患者（软骨肉瘤 34 例，梭形细胞肉瘤 25 例，尤文肉瘤 13 例）。男性 40 例，女性 32 例。平均年龄 49 岁。我们分析了患者、肿瘤和治疗因素与总生存率的关系。平均随访 55 个月（0-302 个月）。
总体 5 年生存率为 44%（尤文肉瘤 60%，软骨肉瘤 57%，梭形细胞肉瘤 30%，去分化软骨肉瘤 0%）。梭形细胞肉瘤和去分化软骨肉瘤的诊断是唯一显著影响生存的不利因素。骨折时间、骨折部位、诊断时的年龄、手术切缘、保肢或截肢对生存无影响。
影响非成骨性原发性骨肉瘤引起的股骨近端病理性骨折后生存的关键因素是去分化软骨肉瘤和梭形细胞肉瘤的组织学诊断。
