Department of Hematology-Oncology, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06106, USA.
Clin Orthop Relat Res. 2012 Jul;470(7):2007-13. doi: 10.1007/s11999-012-2284-9. Epub 2012 Feb 22.
The pelvis is an infrequent site of osteosarcoma and treatment requires surgery plus systemic chemotherapy. Poor survival has been reported, but has not been confirmed previously by the Children's Oncology Group (COG). In addition, survival of patients with pelvic osteosarcomas has not been compared directly with that of patients with nonpelvic disease treated on the same clinical trials.
QUESTIONS/PURPOSES: First, we assessed the event-free (EFS) and overall survival (OS) of patients with pelvic osteosarcoma treated on COG clinical trials. We then asked whether patient survival compared with that of patients treated on the same clinical trials with nonpelvic disease. Finally, we asked whether patients with metastatic disease at initial diagnosis had worse survival.
We retrospectively reviewed data from 1054 patients with osteosarcoma treated in four studies between 1993 and 2005. Twenty-six of the 1054 patients (2.5%) had a primary tumor of the pelvis. At diagnosis, nine patients had metastatic disease. The minimum followup was 2 months (mean, 34 months; range, 2-102 months).
Two of the nine patients with metastatic disease at diagnosis and five of the 17 with localized disease were alive at last contact. Estimates of the 5-year EFS for localized versus metastatic disease of the pelvis were 22% versus 23%. OS for patients with localized versus metastatic disease was 47% versus 22%. Patients with osteosarcoma in all other locations had a 5-year EFS of 57% and OS of 69%.
Our analysis confirms poor survival for patients with pelvic osteosarcoma. Survival with metastatic disease in the absence of a pelvic primary tumor is similar to that for localized or metastatic pelvic osteosarcoma. Improved surgical or medical therapy is needed, and patients with pelvic osteosarcoma may warrant alternate or experimental therapy.
骨盆是骨肉瘤少见的发病部位，治疗需要手术加全身化疗。此前有报道称其生存率较差，但尚未得到儿童肿瘤协作组（COG）的证实。此外，骨盆骨肉瘤患者的生存情况尚未与在相同临床试验中接受治疗的非骨盆疾病患者的生存情况进行直接比较。
问题/目的：首先，我们评估了在 COG 临床试验中接受治疗的骨盆骨肉瘤患者的无事件生存率（EFS）和总生存率（OS）。然后，我们询问患者的生存情况是否与接受相同临床试验中非骨盆疾病治疗的患者进行了比较。最后，我们询问了初诊时存在转移疾病的患者的生存情况是否更差。
我们回顾性分析了 1993 年至 2005 年期间四项研究中 1054 例骨肉瘤患者的数据。1054 例患者中有 26 例（2.5%）为骨盆原发性肿瘤。初诊时，9 例患者存在转移疾病。最低随访时间为 2 个月（平均 34 个月；范围 2-102 个月）。
初诊时存在转移疾病的 9 例患者中有 2 例和局部疾病的 17 例患者中有 5 例在最后一次随访时仍存活。局部与转移性骨盆疾病的 5 年 EFS 估计值分别为 22%和 23%。局部与转移性疾病患者的 OS 分别为 47%和 22%。其他部位骨肉瘤患者的 5 年 EFS 为 57%，OS 为 69%。
我们的分析证实了骨盆骨肉瘤患者的生存率较差。无骨盆原发性肿瘤的转移疾病患者的生存情况与局部或转移性骨盆骨肉瘤患者相似。需要改进手术或药物治疗，骨盆骨肉瘤患者可能需要替代或实验性治疗。
