Department of Oncology, Royal Orthopaedic Hospital, Birmingham, UK.
Aston University Medical School, Birmingham, UK.
Bone Joint J. 2020 Jun;102-B(6):795-803. doi: 10.1302/0301-620X.102B6.BJJ-2019-1307.R1.
To assess the correlation between the histological response to preoperative chemotherapy and event-free survival (EFS) or overall survival (OS) in patients with high-grade localized osteosarcoma.
Out of 625 patients aged ≤ 40 years treated for primary high-grade osteosarcoma between 1997 and 2016, 232 patients without clinically detectable metastases at the time of diagnosis and treated with preoperative high-dose methotrexate, adriamycin and cisplatin (MAP) chemotherapy and surgery were included. Associations of chemotherapy-induced necrosis in the resected specimen and EFS or OS were assessed using Cox model and the Pearson's correlation coefficients (r). Time-dependent receiver operating characteristic analysis was applied to determine the optimal cut-off value of chemotherapy-induced necrosis for EFS and OS.
OS was 74% (95% confidence interval (CI) 67 to 79) at five years. Median chemotherapy-induced necrosis was 85% (interquartile range (IQR) 50% to 97%). In multivariate Cox model, chemotherapy-induced necrosis was significantly associated with EFS and OS (hazard ratio (HR) = 0.99 (95% CI 0.98 to 0.99); p < 0.001 and HR = 0.98 (95% CI 0.97 to 0.99); p < 0.001, respectively). Positive correlation was observed between chemotherapy-induced necrosis and five-year EFS and five-year OS (r = 0.91; p < 0.001, and r = 0.85; p < 0.001, respectively). The optimal cut-off value of chemotherapy-induced necrosis for five-year EFS and five-year OS was 85% and 72%, respectively.
Chemotherapy-induced necrosis in the resected specimen showed positive correlation with EFS and OS in patients with high-grade localized osteosarcoma after MAP chemotherapy. In our analysis, optimal cut-off values of MAP chemotherapy-induced necrosis in EFS and OS were lower than the commonly used 90%, suggesting the need for re-evaluation of the optimal cut-off value through larger, international collaborative research. Cite this article: 2020;102-B(6):795-803.
评估术前化疗的组织学反应与高级别局部骨肉瘤患者的无事件生存（EFS）或总生存（OS）之间的相关性。
在 1997 年至 2016 年间，对 625 名年龄≤40 岁的原发性高级别骨肉瘤患者进行了治疗，其中 232 名患者在诊断时无临床可检测的转移，接受了术前大剂量甲氨蝶呤、阿霉素和顺铂（MAP）化疗和手术治疗。使用 Cox 模型和 Pearson 相关系数（r）评估切除标本中化疗诱导的坏死与 EFS 或 OS 的相关性。应用时间依赖性接受者操作特征分析确定化疗诱导坏死与 EFS 和 OS 的最佳截断值。
五年时 OS 为 74%（95%置信区间[CI]为 67%至 79%）。中位化疗诱导的坏死率为 85%（四分位距[IQR]为 50%至 97%）。在多变量 Cox 模型中，化疗诱导的坏死与 EFS 和 OS 显著相关（风险比[HR]为 0.99（95%CI 为 0.98 至 0.99）；p<0.001 和 HR 为 0.98（95%CI 为 0.97 至 0.99）；p<0.001）。化疗诱导的坏死与五年 EFS 和五年 OS 呈正相关（r=0.91；p<0.001，r=0.85；p<0.001）。化疗诱导的坏死与五年 EFS 和五年 OS 的最佳截断值分别为 85%和 72%。
MAP 化疗后，高级别局限性骨肉瘤患者切除标本中化疗诱导的坏死与 EFS 和 OS 呈正相关。在我们的分析中，EFS 和 OS 中 MAP 化疗诱导的坏死的最佳截断值低于常用的 90%，这表明需要通过更大的国际合作研究重新评估最佳截断值。引用本文：Bone Joint J 2020;102-B(6):795-803.
