病理性骨折对儿童和成人原发性恶性骨肉瘤预后的影响：单中心 205 例回顾性研究。

Impact of Pathological Fractures on the Prognosis of Primary Malignant Bone Sarcoma in Children and Adults: A Single-Center Retrospective Study of 205 Patients.

机构信息

Department of Pediatrics, Wilhelm Sander Sarcoma Unit, Kinderklinik München Schwabing, Klinikum rechts der Isar, Fakultät für Medizin, Technische Universität München, Munich, Germany.

Department of Orthopedic Surgery, Wilhelm Sander Sarcoma Unit, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.

出版信息

Oncology. 2018;94(6):354-362. doi: 10.1159/000487142. Epub 2018 Apr 13.

DOI:10.1159/000487142

PMID:29656296

Abstract

BACKGROUND

The purpose of this study was to investigate whether pathological fractures (PF) influence the prognosis of patients with osteosarcoma (OS) or Ewing tumor (ET) regarding 5-year survival, occurrence of metastases, and local recurrence.

METHODS

We retrospectively analyzed 205 patients with metastatic and nonmetastatic OS or ET. Survival analysis was performed for all patients and differentiated for patients with OS (n = 127) and ET (n = 78) as well as for adults (n = 101) and children (n = 104).

RESULTS

Patients with PF showed survival rates of 64% compared to 83% for those without PF (p = 0.023). Local recurrence occurred in 7% of the patients without and in 24% of those with PF (p = 0.023). In patients with ET and in children, survival analysis showed no significant difference between patients with and without PF in survival and local recurrence rates. In patients with OS, survival rate decreased from 83 to 59% (p = 0.024) and local recurrence rate increased from 13 to 30% (p = 0.042). In adults, survival rate decreased from 78 to 51% (p = 0.004) and local recurrence rate increased from 13 to 42% (p < 0.001). In multivariate analysis, age and PF were associated with inferior survival.

CONCLUSION

This study suggests that the occurrence of PF has a negative impact on survival and implicates an increased risk of local recurrence. In children and in patients with ET, PF did not have a prognostic impact.

摘要

背景

本研究旨在探讨病理性骨折（PF）是否会影响骨肉瘤（OS）或尤因氏肉瘤（ET）患者的预后，包括 5 年生存率、转移发生和局部复发。

方法

我们回顾性分析了 205 例转移性和非转移性 OS 或 ET 患者。对所有患者进行生存分析，并对 OS（n=127）和 ET（n=78）患者以及成人（n=101）和儿童（n=104）患者进行了区分。

结果

PF 患者的生存率为 64%，而无 PF 患者的生存率为 83%（p=0.023）。无 PF 患者的局部复发率为 7%，而有 PF 患者的局部复发率为 24%（p=0.023）。在 ET 患者和儿童中，生存分析显示，有 PF 和无 PF 患者的生存率和局部复发率无显著差异。在 OS 患者中，生存率从 83%降至 59%（p=0.024），局部复发率从 13%升至 30%（p=0.042）。在成人中，生存率从 78%降至 51%（p=0.004），局部复发率从 13%升至 42%（p<0.001）。多因素分析显示，年龄和 PF 与生存率降低相关。