Department of Orthopaedic Surgery, Musculoskeletal Oncology, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
Department of Radiology, University Hospital, LMU Munich, Munich, Germany.
World J Surg Oncol. 2019 Sep 3;17(1):155. doi: 10.1186/s12957-019-1695-4.
Chondrosarcoma is the second most frequent malignant bone tumor. Grade I chondrosarcoma (syn.: atypical cartilaginous tumor) is classified as an intermediately and locally aggressive neoplasm and typically is treated less aggressively (i.e., by intralesional curettage). Does the data regarding local recurrence (LR) and metastatic disease justify this?
From 1982 to 2014, 37 consecutive patients with G1 chondrosarcoma had been resected or curetted. The margin was defined as R0 (wide resection) or R1 (marginal resection). All patients were followed for evidence of local recurrence or metastatic disease. Overall and recurrence-free survival were calculated, and various potentially prognostic factors were evaluated.
In 23 patients (62%), the tumor was widely (R0) resected, whereas in 14 patients, (38%) the resection was marginal (R1). Overall survival was 97% after 5 years, 92% after 10 years, and 67% after 20 years. Five-year local recurrence-free survival was 96%. Ten-year local recurrence-free survival was 83%. Local recurrence-free survival showed a significant correlation to margin status but no correlation to location or age. None of the patients with local recurrence died during the follow-up. One patient had metastatic disease at initial presentation, and a further five patients developed metastatic disease during follow-up. Metastatic disease proofed to be a highly significant factor for survival but was not correlated to local recurrence.
There was no significant correlation between the outcome and the primary tumor location. Marginal resection was a risk factor for LR, but there was no significant difference in the overall survival in patients with or without LR. Metastatic disease (16%) was more common than expected from the literature and a significant predictor for poor overall survival.
软骨肉瘤是第二常见的恶性骨肿瘤。I 级软骨肉瘤（同义词：非典型软骨肿瘤）被归类为中度和局部侵袭性肿瘤，通常治疗不那么积极（即通过腔内刮除术）。局部复发（LR）和转移性疾病的数据是否证明这是合理的？
1982 年至 2014 年，连续 37 例 G1 软骨肉瘤患者接受了切除或刮除治疗。切缘定义为 R0（广泛切除）或 R1（边缘切除）。所有患者均随访以观察局部复发或转移性疾病的证据。计算了总生存率和无复发生存率，并评估了各种潜在的预后因素。
23 例患者（62%）肿瘤广泛（R0）切除，14 例患者（38%）肿瘤边缘切除（R1）。5 年总生存率为 97%，10 年总生存率为 92%，20 年总生存率为 67%。5 年局部无复发生存率为 96%。10 年局部无复发生存率为 83%。局部无复发生存率与切缘状态显著相关，但与位置或年龄无关。无局部复发患者在随访期间死亡。1 例患者初诊时即有转移，另有 5 例患者在随访期间发生转移。转移疾病被证明是生存的一个重要因素，但与局部复发无关。
肿瘤位置与结局之间无显著相关性。边缘切除是 LR 的危险因素，但在有无 LR 的患者中，总生存率无显著差异。转移性疾病（16%）比文献预期更为常见，是总生存率差的显著预测因素。
