Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China.
Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Changsha, China.
World J Surg. 2020 Jul;44(7):2201-2210. doi: 10.1007/s00268-020-05471-9.
Conflicting findings have been reported concerning the survival of patients treated with limb salvage and amputation for osteosarcoma. This study aimed to identify predictors associated with surgery types and survival difference.
Patients with osteosarcoma were selected from the Surveillance Epidemiology and End Results database (1975-2016). Multivariable logistic regression analysis was conducted, and a nomogram was further established. Propensity score matching (PSM)-adjusted Kaplan-Meier curves, log-rank tests, Cox proportional hazards regression analysis were performed to compare overall survival (OS) and cancer-specific survival (CSS).
Among 3363 patients with osteosarcoma, 2447 and 916 underwent limb salvage and amputation. Predictors associated with amputation in the nomogram included age, gender, primary tumor site, tumor grade, tumor stage, tumor size and radiotherapy. Totally 900 pairs of patients treated with limb salvage and amputation were matched after PSM. Limb salvage was significantly associated with improved OS (HR, 0.773; 95% CI, 0.670-0.892; p < 0.001) and CSS (HR, 0.795; 95% CI, 0.681-0.927; p = 0.003) in PSM-adjusted cohort after adjusting for related variables. The significant treatment effect of limb salvage was consistent within most subgroups. Among patients treated with surgery for osteosarcoma, age between 41 and 60, age ≥ 61, pelvis as the primary site, high tumor grade (III/IV), regional and distant tumor stage, tumor size ≥ 92 mm and radiotherapy were independent prognostic factors in PSM cohort.
Limb salvage exhibits significant benefit on OS and CSS compared with amputation for osteosarcoma. Predicators and survival differences should be given full consideration for the treatment of osteosarcoma.
关于骨肉瘤患者接受保肢治疗和截肢治疗的生存情况，已有相互矛盾的研究结果报告。本研究旨在确定与手术类型和生存差异相关的预测因素。
从监测、流行病学和最终结果数据库（1975-2016 年）中选择骨肉瘤患者。进行多变量逻辑回归分析，并进一步建立列线图。进行倾向评分匹配（PSM）调整的 Kaplan-Meier 曲线、对数秩检验、Cox 比例风险回归分析，以比较总生存（OS）和癌症特异性生存（CSS）。
在 3363 例骨肉瘤患者中，2447 例和 916 例接受保肢和截肢治疗。列线图中与截肢相关的预测因素包括年龄、性别、原发肿瘤部位、肿瘤分级、肿瘤分期、肿瘤大小和放疗。经 PSM 后，共匹配了 900 对接受保肢和截肢治疗的患者。保肢治疗与 OS（HR，0.773；95%CI，0.670-0.892；p<0.001）和 CSS（HR，0.795；95%CI，0.681-0.927；p=0.003）的改善显著相关，在调整了相关变量后。在 PSM 调整后的队列中，保肢治疗的显著治疗效果在大多数亚组中是一致的。在接受手术治疗的骨肉瘤患者中，年龄在 41-60 岁、年龄≥61 岁、骨盆为原发部位、高肿瘤分级（III/IV 级）、局部和远处肿瘤分期、肿瘤大小≥92mm 和放疗是 PSM 队列中的独立预后因素。
与截肢相比，保肢治疗在骨肉瘤患者的 OS 和 CSS 方面具有显著优势。对于骨肉瘤的治疗，应充分考虑预测因素和生存差异。
