Chung Lien-Hsiang, Wu Po-Kuei, Chen Cheng-Fong, Weng Hung-Kai, Chen Tain-Hsiung, Chen Wei-Ming
Department of Orthopaedics, Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd., Taipei, 112, Taiwan.
Department of Orthopaedics, Chia-Yi Yang Ming Hospital, Chia-Yi, Taiwan.
BMC Musculoskelet Disord. 2016 Dec 28;17(1):503. doi: 10.1186/s12891-016-1351-x.
Studies reported contradictory results for the prognostic significance of a pathological fracture in osteosarcoma patients. The aim of this study is to report the outcomes for a cohort of patients with osteosarcoma who presented with and without pathological fractures and to identify the prognostic importance of pathological fracture in predicting outcomes and influences on survival.
Data of patients with osteosarcoma were retrospectively reviewed. Between March 1992 and June 2014, a total of 268 patients with osteosarcoma were included in this analysis, of whom 34 (12.7%) with fractures at diagnosis or sustained after chemotherapy and 234 (87.3%) without fracture. All patients were treated with approaches that integrated chemotherapy and surgical resections to maximal extent of all sites whenever feasible. The association between potential prognostic factors and survival for these patients were analyzed and compared.
No significant difference was observed in overall survival, progression free survival, and disease free survival between osteosarcoma patients with pathological fractures and without fracture. The patients without fracture had a 5-year survival of 50% and 10-year survival of 21%, in contrast to 37% (5-year) and 22% (10-year) in patients with fractures. Lung metastasis was the significant predictor for the presence of fractures. Advanced stage (III) of tumor, lung metastasis, poor response to chemotherapy, and local recurrence were associated increased risk for death in all osteosarcoma patients.
Pathological fracture is not a predictor of worse survival in this study. Further studies with matched cases are needed to confirm our observations.
关于骨肉瘤患者病理性骨折的预后意义，研究报告的结果相互矛盾。本研究的目的是报告一组有和没有病理性骨折的骨肉瘤患者的结局，并确定病理性骨折在预测结局及对生存影响方面的预后重要性。
对骨肉瘤患者的数据进行回顾性分析。1992年3月至2014年6月期间，共有268例骨肉瘤患者纳入本分析，其中34例（12.7%）在诊断时或化疗后发生骨折，234例（87.3%）未发生骨折。所有患者均采用在可行的情况下尽可能对所有部位进行化疗和手术切除相结合的治疗方法。分析并比较这些患者潜在预后因素与生存之间的关联。
有和没有病理性骨折的骨肉瘤患者在总生存、无进展生存和无病生存方面未观察到显著差异。未发生骨折的患者5年生存率为50%，10年生存率为21%，相比之下，发生骨折的患者5年生存率为37%，10年生存率为22%。肺转移是骨折发生的显著预测因素。肿瘤晚期（III期）、肺转移、化疗反应差和局部复发与所有骨肉瘤患者死亡风险增加相关。
在本研究中，病理性骨折并非生存较差的预测因素。需要进一步进行配对病例研究以证实我们的观察结果。
