Gill M, McCarthy M, Murrells T, Silcocks P
Department of Community Medicine, University College London.
Lancet. 1988 Mar 26;1(8587):689-92. doi: 10.1016/s0140-6736(88)91485-7.
Examination of the survival rate of 5-year cohorts with primary osteosarcoma registered by the Thames Cancer Registry between 1963 and 1982 and followed up to the end of 1984 showed a borderline significant improvement in survival (test for trend p = 0.05) for patients aged under 25 years at registration, but not for patients 25-64 years. A Cox's proportional hazards model was used to identify effects of sex, period of treatment, whether the patient received chemotherapy, and experience of the hospital. For patients aged under 25 years, a significant (p = 0.02) trend of improved survival was seen among the most recent cohort, and the greater the treatment experience of the hospital, possibly the better the results (p = 0.11), although selective referral cannot be excluded as a reason for this finding. Chemotherapy was not independently associated with survival. Period of treatment, chemotherapy, and experience of hospital were not associated with improved survival for patients aged 25-64. Recent clinical trials for primary osteosarcoma have contributed to an apparent improved survival through selection of patients with good prognosis. Claims for the efficacy of new regimens should be assessed in clinical practice by population monitoring through the analysis of cancer registers.
对泰晤士癌症登记处1963年至1982年间登记的原发性骨肉瘤5年队列生存率进行检查，并随访至1984年底，结果显示，登记时年龄在25岁以下的患者生存率有临界显著改善（趋势检验p = 0.05），但25 - 64岁的患者则没有。采用Cox比例风险模型来确定性别、治疗时期、患者是否接受化疗以及医院经验的影响。对于年龄在25岁以下的患者，在最近的队列中观察到生存率有显著（p = 0.02）的改善趋势，并且医院的治疗经验越丰富，结果可能越好（p = 0.11），尽管不能排除选择性转诊是这一发现的原因。化疗与生存率没有独立关联。治疗时期、化疗和医院经验与25 - 64岁患者的生存率改善无关。最近针对原发性骨肉瘤的临床试验通过选择预后良好的患者，使生存率有了明显提高。新方案疗效的说法应在临床实践中通过对癌症登记处的分析进行人群监测来评估。
