Berlanga Pablo, Cañete Adela, Salom Marta, Montalar Joaquin, Guasp Maria, Marco Alfredo, Castel Victoria
*Pediatric Oncology Unit †Pediatric Orthopedics Unit ‡Medical Oncology Department §Pediatric Radiology Unit ∥Pediatric Surgery Department, Hospital La Fe ¶Cancer Clinical and Translational Research Group, Health Research Institute La Fe, Valencia, Spain.
J Pediatr Hematol Oncol. 2016 Apr;38(3):176-81. doi: 10.1097/MPH.0000000000000546.
The purpose of this study was to analyze the prognostic factors that influence postrelapse survival (PRS) in children and adolescents with initial localized high-grade osteosarcoma.
METHODS/PATIENTS: This is a retrospective evaluation of patients aged 21 years and below with nonmetastatic high-grade osteosarcoma treated at our institution from 1985 to 2011 who developed recurrent disease after achievement of an initial complete response (CR). PRS and postrelapse event-free survival (PREFS) analyses were performed using the Kaplan-Meier method and log-rank test. Multivariate Cox regression analysis was used to determine which variables were independently prognostic.
Thirty-one patients were included. Median age at primary diagnosis was 13.7 years (range, 1.9 to 21.0 y). Median time to first relapse was 16 months (range, 3 to 36 mo). Fourteen patients achieved a second CR (CR2) after surgery±chemotherapy treatment. The 5-year PRS and PREFS were both 26% (95% confidence interval, 14%-49%), with a median follow-up of 99 months (range, 27 to 271 mo). Multivariate analysis showed that achievement of CR2 (P<0.001) and histologic response to first-line treatment (P=0.02) were significantly associated with PRS, whereas time to first relapse did not retain univariate significance.
Achievement of CR2 and histologic response to preoperative first-line treatment are independent survival prognostic factors in osteosarcoma recurrence.
本研究旨在分析影响初发局限性高级别骨肉瘤儿童和青少年复发后生存（PRS）的预后因素。
方法/患者：这是一项对1985年至2011年在我院接受治疗的21岁及以下非转移性高级别骨肉瘤患者的回顾性评估，这些患者在初始完全缓解（CR）后出现疾病复发。使用Kaplan-Meier方法和对数秩检验进行PRS和复发后无事件生存（PREFS）分析。采用多变量Cox回归分析确定哪些变量具有独立的预后意义。
纳入31例患者。初次诊断时的中位年龄为13.7岁（范围1.9至21.0岁）。首次复发的中位时间为16个月（范围3至36个月）。14例患者在手术±化疗后实现了第二次CR（CR2）。5年PRS和PREFS均为26%（95%置信区间，14%-49%），中位随访时间为99个月（范围27至271个月）。多变量分析显示，实现CR2（P<0.001）和对一线治疗的组织学反应（P=0.02）与PRS显著相关，而首次复发时间在单变量分析中无显著意义。
实现CR2和术前一线治疗的组织学反应是骨肉瘤复发的独立生存预后因素。
