对于 41-65 岁的高级别骨肉瘤患者，应优先进行原发灶的确定性手术，而非术前化疗。
Definitive surgery of primary lesion should be prioritized over preoperative chemotherapy to treat high-grade osteosarcoma in patients aged 41-65 years.
机构信息
Department of Orthopedic Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan.
Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
出版信息
J Orthop Traumatol. 2020 Aug 31;21(1):13. doi: 10.1186/s10195-020-00552-w.
BACKGROUND
Recently, the number of osteosarcomas in middle-aged and older patients has demonstrated an increasing trend; moreover, their results are comparatively worse than those of young patients. In Europe and the USA, the prognosis for osteosarcoma in middle-aged and older patients has improved with adjuvant chemotherapy. In Japan, however, the prognosis has remained poor.
MATERIALS AND METHODS
We retrospectively analyzed the outcomes of osteosarcoma, especially in regards to preoperative chemotherapy, from January 1980 to July 2014. A total of 29 patients with high-grade osteosarcoma between the age of 40 and 65 years were included. We included patients without distant metastasis and with primary lesions that were deemed resectable. The mean age was 52.8 years (range 41-65 years), and the mean follow-up period was 103.2 months (range 5-314 months).
RESULTS
Adjuvant chemotherapy was administered to 27 of 29 patients (93%), and 8 of 15 cases (53%) were able to undergo preoperative chemotherapy as planned, including CDDP. A major complication of chemotherapy was acute kidney injury due to CDDP (26%). The 5-year OS and 5-year EFS were 64.9% and 57.1%, respectively. After 2006, a policy to prioritize the resection of the primary lesion was implemented, and if the primary lesion was deemed resectable, preoperative chemotherapy was either not administered or administered for only a short duration. The 5-year OS after 2006 improved to 78.8%.
CONCLUSIONS
This study shows that administration of high-dose intensity preoperative chemotherapy was difficult in middle-aged and older patients due to their high rate of acute kidney injury by CDDP. For cases of osteosarcoma in middle-aged and older patients, if the primary lesion is resectable, preoperative chemotherapy should be minimized to prioritize the resection of the primary lesion. It was considered that, with appropriate measures to prevent complications, adjuvant chemotherapy may lead to improved prognosis.
LEVEL OF EVIDENCE
V.
背景
最近，中年和老年患者的骨肉瘤数量呈上升趋势；此外，他们的治疗效果比年轻患者差。在欧洲和美国，辅助化疗改善了中年和老年患者骨肉瘤的预后。然而，在日本，预后仍然较差。
材料与方法
我们回顾性分析了 1980 年 1 月至 2014 年 7 月间骨肉瘤的治疗结果，特别是术前化疗。共纳入 29 例年龄在 40 至 65 岁之间的高级别骨肉瘤患者。纳入标准为无远处转移且原发肿瘤可切除的患者。患者的平均年龄为 52.8 岁（41-65 岁），平均随访时间为 103.2 个月（5-314 个月）。
结果
29 例患者中有 27 例（93%）接受了辅助化疗，15 例中有 8 例（53%）按计划接受了术前化疗，包括顺铂（CDDP）。化疗的主要并发症是 CDDP 引起的急性肾损伤（26%）。5 年 OS 和 5 年 EFS 分别为 64.9%和 57.1%。2006 年后，我们实施了优先切除原发肿瘤的策略，如果原发肿瘤可切除，则不给予术前化疗或仅短时间给予术前化疗。2006 年后，5 年 OS 提高至 78.8%。
结论
本研究表明，由于 CDDP 引起的急性肾损伤发生率较高，中年和老年患者难以接受大剂量强度的术前化疗。对于中年和老年患者的骨肉瘤，如果原发肿瘤可切除，应尽量减少术前化疗，优先切除原发肿瘤。考虑到适当的并发症预防措施，辅助化疗可能会改善预后。
证据等级
V。
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