Sofulu Ömer, Erol Bülent
Department of Orthopaedic Surgery and Traumatology, Marmara University, School of Medicine, İstanbul, Turkey.
Acta Orthop Traumatol Turc. 2020 May;54(3):234-244. doi: 10.5152/j.aott.2020.03.79.
This study is an evaluation of the overall survival rate and factors affecting survival in patients with osteosarcoma, chondrosarcoma, or Ewing's sarcoma. This study aimed to determine the effect of factors related to the preoperative period, patient, tumor, treatment, and postoperative period on survival.
A total of 114 patients (64 male and 50 female) with osteosarcoma, chondrosarcoma, or Ewing's sarcoma treated between 2005 and 2013 were included in this study. All the patients received standard treatment and were followed up regularly. In all, 44 cases of (conventional and telangiectatic) osteosarcoma, 30 cases of Ewing's sarcoma, and 40 cases of high-grade chondrosarcoma were identified using the Bone and Soft Tissue Tumor Registry. Gender, age, tumor size and localization, pathological fractures, histopathological type, grade, surgical treatment, adjuvant treatments, relapse of the disease, and postoperative complication data were obtained from follow-up forms. The learning curve of institutional expertise was also evaluated. The patient survival rate was calculated using the Kaplan-Meier method, and log-rank statistical methods were used to compare survival rates.
The mean length of survival of the patients was 72 months. There was a 56% 5-year survival rate, and the event-free survival rate was 53%. The survival of patients with Ewing's sarcoma whose prodromal period was less than 12 weeks was significantly higher than that of the other groups (p=0.031). The survival of patients with tumor size greater than 150 cc, with local recurrence and distant metastases was low for all groups. Survival rates were significantly lower in osteosarcoma and Ewing's sarcoma patients with stage III tumor or metastasis at diagnosis. The survival of patients with osteosarcoma diagnosed between 2010 and 2013 was significantly higher than that of the earlier group (p=0.02).
Decreasing the prodromal period (early diagnosis) can improve survival by preventing the local and systemic spread of the tumor. Increase in the surgical experience is likely to have a positive effect on survival rates, especially for patients with osteosarcoma. The relapse of the disease is a poor prognostic factor for survival despite aggressive surgery and adjuvant therapies.
Level IV, Therapeutic study.
本研究旨在评估骨肉瘤、软骨肉瘤或尤因肉瘤患者的总生存率及影响生存的因素。本研究旨在确定与术前阶段、患者、肿瘤、治疗及术后阶段相关的因素对生存的影响。
本研究纳入了2005年至2013年间接受治疗的114例骨肉瘤、软骨肉瘤或尤因肉瘤患者（64例男性，50例女性）。所有患者均接受标准治疗并定期随访。通过骨与软组织肿瘤登记处确定了44例（传统型和毛细血管扩张型）骨肉瘤、30例尤因肉瘤和40例高级别软骨肉瘤。从随访表格中获取性别、年龄、肿瘤大小和部位、病理性骨折、组织病理学类型、分级、手术治疗、辅助治疗、疾病复发及术后并发症数据。还评估了机构专业知识的学习曲线。采用Kaplan-Meier方法计算患者生存率，并使用对数秩统计方法比较生存率。
患者的平均生存时长为72个月。5年生存率为56%，无事件生存率为53%。前驱期少于12周的尤因肉瘤患者的生存率显著高于其他组（p=0.031）。肿瘤大小大于150立方厘米、有局部复发和远处转移的患者在所有组中的生存率都较低。诊断时为III期肿瘤或有转移的骨肉瘤和尤因肉瘤患者的生存率显著较低。2010年至2013年间诊断出的骨肉瘤患者的生存率显著高于早期组（p=0.02）。
缩短前驱期（早期诊断）可通过防止肿瘤的局部和全身扩散来提高生存率。手术经验的增加可能对生存率产生积极影响，尤其是对骨肉瘤患者。尽管进行了积极的手术和辅助治疗，但疾病复发仍是生存的不良预后因素。证据级别：IV级，治疗性研究。
