Department of Orthopaedic Surgery, Konkuk University School of Medicine, Konkuk University Hospital, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 143-729, Republic of Korea. E-mail address:
Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea. E-mail address for I. Han:
J Bone Joint Surg Am. 2014 Apr 16;96(8):e60. doi: 10.2106/JBJS.K.01577.
Little is known concerning erroneous surgical procedures of malignant bone tumors, and the prognostic effect of erroneous surgical procedures in osteosarcoma has not been determined.
We retrospectively reviewed 240 patients with initially non-metastatic high-grade osteosarcoma of the pelvis and extremities and, of these, identified twenty-six who had undergone previous less appropriate surgical procedures due to misdiagnosis followed by adequate treatment at our institution. We evaluated the clinicopathologic characteristics of these twenty-six patients compared with the remaining 214 patients treated with regular protocol. Subsequently, thirty-eight patients (nineteen in the matched case group and nineteen in the matched control group) were matched for multiple different variables using propensity score matching, and the oncologic results in terms of event-free survival and overall survival were analyzed.
The patients undergoing erroneous surgical procedures were typically older, with small, non-osteoblastic-type tumors that were in an unusual location, showed an osteolytic pattern on radiographs, had a tendency toward marginal or intralesional excision with positive histologic margin, and had not been treated with neoadjuvant chemotherapy (all p < 0.05). After adjustment of confounding variables by propensity score matching, there was no significant difference between matched groups with regard to event-free survival (p = 0.46) and overall survival (p = 0.99).
Distinct differences existed in the clinicopathologic characteristics of the patients who underwent erroneous surgical procedures due to misdiagnosis. We failed to detect a prognostic relevance of the presence of previous erroneous procedures followed by adequate treatment.
对于恶性骨肿瘤的错误手术操作知之甚少，且在骨肉瘤中，错误手术操作的预后影响尚未确定。
我们回顾性分析了 240 例初诊无转移的骨盆和四肢高级别骨肉瘤患者，其中 26 例患者因误诊而接受了先前不太合适的手术治疗，随后在我们的机构接受了充分的治疗。我们评估了这 26 例患者的临床病理特征，并与其余 214 例接受常规方案治疗的患者进行了比较。随后，通过倾向评分匹配，对 38 例患者（匹配病例组 19 例，匹配对照组 19 例）进行了多种不同变量的匹配，并分析了无事件生存和总生存的肿瘤学结果。
接受错误手术的患者通常年龄较大，肿瘤较小，呈非成骨样类型，位于不常见的部位，影像学表现为溶骨性，倾向于边缘或腔内切除，组织学边缘阳性，且未接受新辅助化疗（均 p < 0.05）。通过倾向评分匹配调整混杂变量后，匹配组在无事件生存（p = 0.46）和总生存（p = 0.99）方面无显著差异。
由于误诊而接受错误手术的患者在临床病理特征方面存在明显差异。我们未能检测到先前错误手术治疗后进行充分治疗的预后相关性。
