Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
Cancer. 2013 Jul 15;119(14):2645-53. doi: 10.1002/cncr.28111. Epub 2013 Apr 26.
Chemotherapy has improved the outcome of patients with newly diagnosed osteosarcoma, but its role in relapsed disease is unclear.
We reviewed the records of all patients who were treated for relapsed high-grade osteosarcoma at our institution between 1970 and 2004. Postrelapse event-free survival (PREFS) and postrelapse survival (PRS) were estimated, and outcome comparisons were made using an exact log-rank test.
The 10-year PREFS and PRS of the 110 patients were 11.8% ± 3.5% and 17.0% ± 4.3%, respectively. Metastasis at initial diagnosis (14%), and relapse in lung only (75%) were not significantly associated with PREFS or PRS. Time from initial diagnosis to first relapse (RL1) ≥18 months (43%), surgery at RL1 (76%), and ability to achieve second complete remission (CR2, 56%) were favorably associated with PREFS and PRS (P ≤ 0.0002). In patients without CR2, chemotherapy at RL1 was favorably associated with PREFS (P = 0.01) but not with PRS. In patients with lung relapse only, unilateral relapse and number of nodules ( ≤ 3) were associated with better PREFS and PRS (P ≤ 0.0005); no patients with bilateral relapse survived 10 years. The median PREFS after treatment with cisplatin, doxorubicin, methotrexate, and ifosfamide was 3.5 months (95% confidence interval, 2.1-5.2), and the median PRS was 8.2 months (95% confidence interval, 5.2-15.1).
Late relapse, surgical resection, and unilateral involvement (in lung relapse only) favorably impact outcome after relapse. Surgery is essential for survival; chemotherapy may slow disease progression in patients without CR2. These data are useful for designing clinical trials that evaluate novel agents.
化疗已经改善了新诊断骨肉瘤患者的预后，但它在复发性疾病中的作用尚不清楚。
我们回顾了 1970 年至 2004 年期间在我院接受复发性高级别骨肉瘤治疗的所有患者的记录。估计了复发后无事件生存（PREFS）和复发后生存（PRS），并通过精确对数秩检验进行了结果比较。
110 例患者的 10 年 PREFS 和 PRS 分别为 11.8%±3.5%和 17.0%±4.3%。初诊时转移（14%）和仅肺部复发（75%）与 PREFS 或 PRS 无显著相关性。初诊至首次复发（RL1）时间≥18 个月（43%）、RL1 时手术（76%）和能够实现第二次完全缓解（CR2，56%）与 PREFS 和 PRS 呈正相关（P≤0.0002）。在未达到 CR2 的患者中，RL1 时的化疗与 PREFS 呈正相关（P=0.01），但与 PRS 无关。仅肺部复发的患者中，单侧复发和结节数（≤3 个）与更好的 PREFS 和 PRS 相关（P≤0.0005）；无双侧复发的患者存活 10 年。顺铂、多柔比星、甲氨蝶呤和异环磷酰胺治疗后的中位 PREFS 为 3.5 个月（95%置信区间，2.1-5.2），中位 PRS 为 8.2 个月（95%置信区间，5.2-15.1）。
晚期复发、手术切除和单侧受累（仅肺部复发）对复发后结局有利。手术是生存的关键；化疗可能会减缓无 CR2 患者的疾病进展。这些数据有助于设计评估新型药物的临床试验。
