Deng Zhi-Ping, Ding Yi, Puri Ajay, Wang Edward H M, Gulia Ashish, Durban Claire, Niu Xiao-Hui
Department of Orthopaedic Oncology Surgery, Beijing Ji Shui Tan Hospital, Peking University, Beijing 100035, China.
Chin Med J (Engl). 2015 Oct 5;128(19):2605-8. doi: 10.4103/0366-6999.166025.
Recent studies have suggested that the presence of a pathological fracture does not impact on oncologic outcomes and the feasibility of limb salvage surgery (LSS) in appropriately selected patients when combined with neoadjuvant chemotherapy. These have largely been single institutional studies with limited numbers. The Eastern Asian Musculoskeletal Oncology Group reviewed the data from three large volume Asian orthopedic oncology centers to determine whether the presence of a pathologic fracture affected outcomes in osteosarcoma patients.
A retrospective review of the data was conducted. Ninety-five cases of nonmetastatic extremity osteosarcoma with a pathological fracture and 887 cases without fracture treated during the same period were compared.
In the fracture group, the LSS rate was 62.1%, and the rate of amputation was 37.9%. In the nonfracture group, the LSS rate was 74.7%, and the amputation was 25.3%. In patients with a pathologic fracture, the rate of local recurrence for LSS and amputation groups was 8.5% and 2.8%, respectively. In this group, the 5-year survival in the LSS group was 66% as against. 46.8% in the amputation group.
Our study suggests that surgically treated patients with pathologic fractures in osteosarcoma have adequate local control and do not have a poorer outcome compared to patients without a fracture. Though osteosarcoma with a pathologic fracture is not a contraindication for limb salvage, appropriate case selection is important when deciding local control options to ensure adequate oncologic clearance.
近期研究表明，病理性骨折的存在并不影响肿瘤学预后，对于经过适当选择的患者，在联合新辅助化疗时肢体挽救手术（LSS）具有可行性。这些研究大多是单机构研究，样本量有限。东亚肌肉骨骼肿瘤学组回顾了来自三个大型亚洲骨科肿瘤中心的数据，以确定病理性骨折的存在是否会影响骨肉瘤患者的预后。
对数据进行回顾性分析。比较了95例伴有病理性骨折的非转移性肢体骨肉瘤病例和同期治疗的887例无骨折病例。
骨折组的LSS率为62.1%，截肢率为37.9%。非骨折组的LSS率为74.7%，截肢率为25.3%。在有病理性骨折的患者中，LSS组和截肢组的局部复发率分别为8.5%和2.8%。在该组中，LSS组的5年生存率为66%，而截肢组为46.8%。
我们的研究表明，骨肉瘤伴有病理性骨折且接受手术治疗的患者具有足够的局部控制，与无骨折患者相比，预后并不更差。虽然伴有病理性骨折的骨肉瘤并非肢体挽救的禁忌证，但在决定局部控制方案时，适当的病例选择对于确保足够的肿瘤学切缘很重要。
