Tumour, Sepsis and Reconstruction Unit, Department of Orthopaedic Surgery, Greys Hospital, University of KwaZulu-Natal, Pietermaritzburg, South Africa.
S Afr Med J. 2012 Jun 28;102(8):673-6. doi: 10.7196/samj.5835.
Osteosarcoma is the most common malignant bone tumour found in children and adolescents. Changed treatment protocols have resulted in improved survival and the opportunity for limb salvage surgery. Despite these advances, the outcome is mainly determined by the stage of disease at presentation, making early referral to a tumour unit essential.
Between July 2009 and October 2011, 25 consecutive patients were diagnosed with biopsy-confirmed osteosarcoma. Their records were reviewed and information extracted regarding clinical presentation, histological subtype and stage of disease.
Twenty-four patients met the inclusion and exclusion criteria. Conventional osteosarcoma was the most common histological diagnosis encountered; 16 out of 24 (66.7%) patients had metastases at presentation; 6 of the remaining had advanced local disease with very large tumours or pathological fractures that precluded limb salvage surgery.
The great majority of patients referred to our tumour unit present with locally advanced or metastatic disease, which limits treatment options and adversely affects survival. Increased awareness, a high index of suspicion and appropriate early referral is crucial to enable limb salvage surgery and increase disease-free survival rates.
骨肉瘤是儿童和青少年中最常见的恶性骨肿瘤。治疗方案的改变导致了生存率的提高，并为保肢手术提供了机会。尽管取得了这些进展，但疾病的分期仍然是决定预后的主要因素，因此早期转至肿瘤专科至关重要。
2009 年 7 月至 2011 年 10 月，我们连续诊断了 25 例经活检证实的骨肉瘤患者。我们对其病历进行了回顾，并提取了有关临床表现、组织学亚型和疾病分期的信息。
24 例患者符合纳入和排除标准。最常见的组织学诊断是传统型骨肉瘤；24 例患者中，16 例（66.7%）患者在就诊时已发生转移；其余 6 例患者的局部疾病已进展，肿瘤巨大或存在病理性骨折，无法进行保肢手术。
我们肿瘤专科接诊的大多数患者均存在局部晚期或转移性疾病，这限制了治疗选择，对生存率产生了不利影响。提高认识、保持高度警惕并进行适当的早期转诊，对于实施保肢手术和提高无病生存率至关重要。
