Tirtei Elisa, Asaftei Sebastian D, Manicone Rosaria, Cesari Marilena, Paioli Anna, Rocca Michele, Ferrari Stefano, Fagioli Franca
1 Pediatric Oncohematology, Stem Cell Transplantation and Cell Therapy Division, A.O.U. Città della Salute e della Scienza, Ospedale Infantile "Regina Margherita", Turin - Italy.
2 Chemotherapy Unit, Istituto Ortopedico Rizzoli, Bologna - Italy.
Tumori. 2017 May 1:tj5000636. doi: 10.5301/tj.5000636.
Purpose Osteosarcoma (OS) is the most common primary bone tumor. Despite complete surgical removal and intensive chemotherapeutic treatment, 30%-35% of patients with OS have local or systemic recurrence. Some patients survive multiple recurrences, but overall survival after OS recurrence is poor. This analysis aims to describe and identify factors influencing post-relapse survival (PRS) after a second OS relapse. Methods This is a retrospective analysis of 60 patients with a second relapse of OS of the extremities in 2 Italian centers between 2003 and 2013. Results Treatment for first and subsequent relapses was planned according to institutional guidelines. After complete surgical remission (CSR) following the first recurrence, patients experienced a second OS relapse with a median disease-free interval (DFI) of 6 months. Lung disease was prevalent: 44 patients (76%) had pulmonary metastases. Survival after the second relapse was 22% at 5 years. Lung disease only correlated with better survival at 5 years (33.6%) compared with other sites of recurrence (5%; p = 0.008). Patients with a single pulmonary lesion had a better 5-year second PRS (42%; p = 0.02). Patients who achieved a second CSR had a 5-year second PRS of 33.4%. Chemotherapy (p<0.001) benefited patients without a third CSR. Conclusions This analysis confirms the importance of an aggressive, repeated surgical approach. Lung metastases only, the number of lesions, DFI and CSR influenced survival. It also confirms the importance of chemotherapy in patients in whom surgical treatment is not feasible.
目的 骨肉瘤（OS）是最常见的原发性骨肿瘤。尽管进行了完整的手术切除和强化化疗，但30%-35%的骨肉瘤患者会出现局部或全身复发。一些患者能在多次复发后存活，但骨肉瘤复发后的总体生存率较差。本分析旨在描述和识别影响骨肉瘤第二次复发后复发后生存（PRS）的因素。方法 这是一项对2003年至2013年间意大利两个中心60例四肢骨肉瘤第二次复发患者的回顾性分析。结果 首次及后续复发的治疗均根据机构指南进行规划。首次复发后达到完全手术缓解（CSR）的患者出现第二次骨肉瘤复发，中位无病间期（DFI）为6个月。肺部疾病较为普遍：44例患者（76%）有肺转移。第二次复发后的5年生存率为22%。与其他复发部位相比，肺部疾病仅与5年时较好的生存率相关（33.6%对5%；p = 0.008）。单一肺部病变的患者5年第二次PRS较好（42%；p = 0.02）。实现第二次CSR的患者5年第二次PRS为33.4%。化疗（p<0.001）对未出现第三次CSR的患者有益。结论 本分析证实了积极、重复手术方法的重要性。仅肺转移、病变数量、DFI和CSR影响生存。它还证实了化疗在手术治疗不可行的患者中的重要性。
