Nagano Akihito, Matsumoto Seiichi, Kawai Akira, Okuma Tomotake, Hiraga Hiroaki, Matsumoto Yoshihiro, Nishida Yoshihiro, Yonemoto Tsukasa, Hosaka Masami, Takahashi Mitsuru, Yoshikawa Hideki, Kunisada Toshiyuki, Asanuma Kunihiro, Naka Norifumi, Emori Makoto, Kubo Tadahiko, Kawashima Hiroyuki, Kawamoto Teruya, Yokoyama Ryohei, Tsukushi Satoshi, Sato Kenji, Okamoto Takeshi, Hiraoka Koji, Morioka Hideo, Tanaka Kazuhiro, Takagi Tatsuya, Iwamoto Yukihide, Ozaki Toshifumi
The Department of Orthopaedic Surgery, Gifu University School of Medicine, 1-1 Yanagido, Gifu, 501-1193, Japan.
The Department of Orthopaedic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
J Orthop Sci. 2020 Mar;25(2):319-323. doi: 10.1016/j.jos.2019.04.008. Epub 2019 May 30.
Primary osteosarcoma in elderly patients are rare malignant tumors. Its optimal treatment has not yet been determined.
This retrospective study included 104 patients aged >50 years with resectable, non-metastatic osteosarcoma treated by the members of the Bone and Soft Tissue Tumor Study Group of the Japan Clinical Oncology Group. The effects of adjuvant chemotherapy were estimated by comparing outcomes in patients who received surgery plus chemotherapy with those who underwent surgery alone.
Median age at presentation was 59 years. Neoadjuvant and adjuvant chemotherapy was administered to 83 (79.8%) patients. Patients who underwent surgery plus chemotherapy and those who underwent surgery alone had 5-year overall survival (OS) rates of 68.6% and 71.7%, respectively (p = 0.780), and 5-year relapse free survival (RFS) rates of 48.2% and 43.6%, respectively (p = 0.64). Univariate analysis showed that resection with wide margins was significantly correlated with better prognosis.
The addition of chemotherapy to surgery did not improve OS or RFS in patients aged >50 years with resectable, non-metastatic osteosarcoma. Surgery with wide margins was only significantly prognostic of improved survival. The effect of chemotherapy in elderly osteosarcoma patients was unclear.
老年患者的原发性骨肉瘤是罕见的恶性肿瘤。其最佳治疗方案尚未确定。
这项回顾性研究纳入了104例年龄>50岁、可切除的非转移性骨肉瘤患者，这些患者由日本临床肿瘤学会骨与软组织肿瘤研究组的成员进行治疗。通过比较接受手术加化疗的患者与仅接受手术的患者的结局，评估辅助化疗的效果。
就诊时的中位年龄为59岁。83例（79.8%）患者接受了新辅助化疗和辅助化疗。接受手术加化疗的患者和仅接受手术的患者的5年总生存率（OS）分别为68.6%和71.7%（p = 0.780），5年无复发生存率（RFS）分别为48.2%和43.6%（p = 0.64）。单因素分析显示，广泛切缘切除与更好的预后显著相关。
对于年龄>50岁、可切除的非转移性骨肉瘤患者，手术加化疗并未改善总生存率或无复发生存率。广泛切缘手术是生存改善的唯一显著预后因素。化疗在老年骨肉瘤患者中的效果尚不清楚。
