Department of Orthopedics, UCLA Orthopedic Hospital, David Geffen School of Medicine at UCLA, University of California-Los Angeles, Los Angeles, California 90095-1782, USA.
Cancer. 2012 Dec 1;118(23):5888-93. doi: 10.1002/cncr.27651. Epub 2012 May 30.
The authors present the long-term follow-up (>25 years) data from 1 of the original prospective, randomized trials that compared adjuvant chemotherapy with expectant management in patients with high-grade, localized osteosarcoma. In addition, the value of pathologic necrosis induced by a single cycle of neoadjuvant chemotherapy was analyzed as a predictive marker of disease-free and overall survival.
Fifty-nine patients with high-grade, localized osteosarcoma were enrolled in a prospective trial that was performed between 1981 and 1984 at the University of California-Los Angeles (UCLA). Patients were randomized to receive either adjuvant chemotherapy or observation after surgical resection. Long-term outcomes, follow-up, and pathologic review of all available histologic sections were performed.
The 25-year disease-free survival rate was 28% for patients who received adjuvant chemotherapy compared with 15% for the untreated patients (P = .02). The overall survival rate at 25 years was also significantly higher for treated patients versus untreated patients (38% vs 15%; P = .02). Tumor necrosis >90% after a single round of chemotherapy was a statistically significant predictor of overall survival and disease-free survival for patients who received adjuvant therapy (164 months vs 65 months [P = .04] and 141 months vs 14 months [P < .01], respectively).
Patients with high-grade, localized osteosarcoma who received adjuvant chemotherapy after undergoing definitive surgical resection had a statistically significant benefit in disease-free and overall survival that was maintained through 25 years. Tumor necrosis after just 1 cycle of neoadjuvant chemotherapy and radiation was predictive of overall survival and disease-free survival in patients who received adjuvant chemotherapy.
作者报告了其中 1 项原始前瞻性随机试验的长期随访（>25 年）数据，该试验比较了辅助化疗与高分级局部骨肉瘤患者的期待治疗。此外，还分析了新辅助化疗 1 周期诱导的病理坏死作为无病生存和总生存的预测标志物的价值。
1981 年至 1984 年，加利福尼亚大学洛杉矶分校（UCLA）进行了一项前瞻性试验，纳入 59 例高分级局部骨肉瘤患者。患者被随机分配接受辅助化疗或手术后观察。对所有可用组织学切片进行长期结果、随访和病理复查。
接受辅助化疗的患者 25 年无病生存率为 28%，未治疗患者为 15%（P=.02）。治疗组患者的 25 年总生存率也明显高于未治疗组（38%比 15%；P=.02）。接受辅助治疗的患者，化疗 1 周期后肿瘤坏死率>90%是总生存率和无病生存率的统计学显著预测因子（164 个月比 65 个月[P=.04]和 141 个月比 14 个月[P<.01]）。
接受确定性手术切除后接受辅助化疗的高分级局部骨肉瘤患者，在无病生存和总生存方面有显著获益，且维持 25 年。接受辅助化疗的患者，新辅助化疗和放疗 1 周期后的肿瘤坏死是总生存率和无病生存率的预测因子。
