Wuisman P, Enneking W F
W. Thaxton Springfield Center for Orthopaedic Study and Research, University of Florida Health Center, Gainesville 32610.
J Bone Joint Surg Am. 1990 Jan;72(1):60-8.
We analyzed the cases of twenty-three patients who had Stage-IIB osteosarcoma and skip metastasis to determine the rates of disease-free and long-term survival. The regimens of preoperative and postoperative chemotherapy varied. The patterns of relapse and long-term survival were studied in relation to the skip lesions, and these patterns were compared with those of 224 patients who had Stage-II osteosarcoma but no skip lesion. Of the twenty-three patients who had a skip lesion, twenty-two had either a local recurrence or a distant metastasis; twenty-two patients died, and one remained disease-free at thirty-eight months. Kaplan-Meier analysis showed significant differences in the rates of local recurrence and distant metastasis (Mantel-Cox test statistic, p less than 0.0001) and in the over-all survival (Mantel-Cox test statistic, p less than 0.0001) between the patients who had and those who did not have skip metastasis. The cases of fourteen patients who had skip metastasis from a lesion in the distal end of the femur were compared with those of eighty-seven patients who had a similarly situated primary lesion but no skip metastasis. The difference was significant, although less so than when lesions in all anatomical sites were analyzed. The follow-up data indicated that the use of adjuvant chemotherapy did not improve the poor prognosis of patients who had skip metastasis. Therefore, we regard a skip lesion, along with regional lymphatic metastasis or metastasis to a distant organ, as another criterion for considering an osteosarcoma to be Stage III.
我们分析了23例患有IIB期骨肉瘤并伴有跳跃转移的患者病例，以确定无病生存率和长期生存率。术前和术后化疗方案各不相同。研究了与跳跃病灶相关的复发模式和长期生存情况，并将这些模式与224例患有II期骨肉瘤但无跳跃病灶的患者进行了比较。在23例有跳跃病灶的患者中，22例出现了局部复发或远处转移；22例患者死亡，1例在38个月时仍无疾病。Kaplan-Meier分析显示，有跳跃转移和无跳跃转移的患者在局部复发率、远处转移率（Mantel-Cox检验统计量，p<0.0001）以及总生存率（Mantel-Cox检验统计量，p<0.0001）方面存在显著差异。将14例股骨远端病灶出现跳跃转移的患者病例与87例有类似位置的原发病灶但无跳跃转移的患者病例进行了比较。差异显著，尽管不如分析所有解剖部位的病灶时那么明显。随访数据表明，辅助化疗并不能改善有跳跃转移患者的不良预后。因此，我们将跳跃病灶与区域淋巴结转移或远处器官转移一起，视为将骨肉瘤判定为III期的另一个标准。
