新辅助化疗后残留存活肿瘤细胞的位置：骨肉瘤中具有高预后性能的新概念。

Location of residual viable tumor cells after neoadjuvant chemotherapy: A new concept with high prognostic performance in osteosarcoma.

作者信息

Kim Seung Hyun, Shin Kyoo-Ho, Moon Seong-Hwan, Kong Youngho, Suh Jin-Suck, Yang Woo-Ick

机构信息

Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea.

Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.

出版信息

J Surg Oncol. 2017 May;115(6):752-759. doi: 10.1002/jso.24571. Epub 2017 Apr 12.

DOI:10.1002/jso.24571

PMID:28403564

Abstract

BACKGROUND AND OBJECTIVES

The purpose of this study was to establish a new concept for evaluating responses to neoadjuvant chemotherapy in osteosarcoma.

METHODS

A total of 56 high-grade extremity osteosarcoma patients were retrospectively reviewed. A new conceptual method was derived from locations of residual viable tumor cells (LRVTC) after chemotherapy, whether extracompartmental or intracompartmental, rather than quantitative measurements of necrosis rates of tumor cells.

RESULTS

LRVTC after chemotherapy was independently associated with overall survival ([OS]hazard ratio [HR] = 6.502, P = 0.008) after adjustment for Huvos grade (HR = 3.694, P = 0.045), alkaline phosphatase ([ALP] HR = 2.140, P = 0.226), size (HR = 0.318, P = 0.133), joint extension (HR = 2.309, P = 0.162), and metastasis at diagnosis (HR = 8.228, P = 0.009). LRVTC was also independently associated with metastasis (HR = 5.096, P = 0.002) after adjustment for Huvos grade (HR = 2.261, P = 0.101), ALP (HR = 2.558, P = 0.053), size (HR = 1.280, P = 0.641), and joint extension (HR = 1.800, P = 0.254). AUC values of LRVTC for OS and metastasis were superior to those of Huvos grade: AUCs for OS (LRVTC: 0.757, Confidence Interval [CI] = 0.618 to 0.865 vs Huvos grade: 0.590, [CI] = 0.445 to 0.725; AUC = 0.167, P = 0.086) and metastasis (LRVTC: 0.769, CI = 0.631 to 0.874 vs Huvos grade: 0.606, [CI] = 0.461 to 0.739; AUC = 0.163, P = 0.046).

CONCLUSIONS

LRVTC after chemotherapy may be useful as a new method with high performance for evaluating chemo-responses in osteosarcoma.

摘要

背景与目的

本研究旨在建立一种评估骨肉瘤新辅助化疗反应的新概念。

方法

回顾性分析56例肢体高级别骨肉瘤患者。一种新的概念方法源自化疗后残留存活肿瘤细胞（LRVTC）的位置，无论其位于间室外还是间室内，而非肿瘤细胞坏死率的定量测量。

结果

校正Huvos分级（风险比[HR]=3.694，P=0.045）、碱性磷酸酶（[ALP] HR=2.140，P=0.226）、肿瘤大小（HR=0.318，P=0.133）、关节伸展度（HR=2.309，P=0.162）及诊断时有无转移（HR=8.228，P=0.009）后，化疗后的LRVTC与总生存期（[OS] HR=6.502，P=0.008）独立相关。校正Huvos分级（HR=2.261，P=0.101）、ALP（HR=2.558，P=0.053）、肿瘤大小（HR=1.280，P=0.641）及关节伸展度（HR=1.800，P=0.254）后，LRVTC也与转移独立相关（HR=5.096，P=0.002）。LRVTC对OS和转移的曲线下面积（AUC）值优于Huvos分级：OS的AUC（LRVTC：0.757，置信区间[CI]=0.618至0.865；Huvos分级：0.590，[CI]=0.445至0.725；AUC=0.167，P=0.086）及转移的AUC（LRVTC：0.769，CI=0.631至0.874；Huvos分级：0.606，[CI]=0.461至0.739；AUC=0.163，P=0.046）。